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DOPPS Practice Monitor shows continued decline in hemoglobin and rise in parathyroid hormone levels for dialysis patients

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The Dialysis Outcomes and Practice Patterns Study Practice Monitor has released more than 800 regularly updated charts, figures, and data tables. Emerging trends in U.S. hemodialysis practice through August 2014, based on a national sample of U.S dialysis facilities, are included in the latest DPM update, at DOPPS.org/DPM.

Beginning with the October 2014 update, the DPM sample was expanded by more than 8,000 patients and 100 dialysis facilities thanks to a partnership with Visonex, LLC, a provider of electronic medical record and patient management software for small-chain, independent, and hospital-based dialysis clinics. Data from participating facilities using the Visonex EMR were added retroactively to DPM cross-sections from March 2012 onward, providing greater stability of national and stratum-specific estimates.

The DPM now includes more than four years of trends in U.S. dialysis care, including comparisons by race, rural location, and affiliated chain size. The DPM has provided the following trends from August 2010 to August 2014:

• Mean hemoglobin levels declined from 11.5 g/dl to 10.9 g/dl (10.7 g/dl among patients treated with an erythropoiesis-stimulating agent); median Hgb levels followed a similar trend. The percentage of patients with Hgb >12 g/dl declined from 31.3% to 14.2% and the percentage with Hgb <10 g/dl rose from 8.3% to 19.1%.
• Mean weekly prescribed intravenous epoetin dose declined from 20,100 units to 12,800 units (-37%), and median EPO doses declined from 13,100 units to 8,400 units (-36%). Many facilities now limit weekly EPO doses to 30,000 units.
• Mean serum ferritin levels have increased from 654 ng/ml to 764 ng/ml (+17%), and median serum ferritin levels increased from 596 ng/ml to 715 ng/ml (+20%). The percentage of patients with ferritin above 800 ng/ml increased from 31.1% to 40.1%.
• Mean serum parathyroid hormone levelsincreased from 408 pg/ml to 540 pg/ml (+32%) in black patients and from 297 pg/ml to 404 pg/ml in non-black patients (+36%). The percentage of patients with PTH above 600 pg/ml increased from 16.5% to 27.3% in black patients and from 8.0% to 15.9% in non-black patients. 

The DPM now provides graphics demonstrating large facility-level variation in risks of transfusion and hospitalization recorded in Medicare claims data. For example, the facility percentage of patients transfused over six months ranged from 3.8% (10^thpercentile) to 19% (90^thpercentile), a five-fold variation.

The DOPPS has followed international trends for over a decade, and 2012 was the first year that mean Hgb levels were lower in the U.S. than in Europe, Canada, and Australia/New Zealand. Median prescribed epoetin doses in the U.S. are now generally similar to these other countries, while serum ferritin levels are substantially higher in the U.S.

DOPPS will host a web conference on the latest DPM update, Thursday, Jan. 15 at 3 p.m. EST.