Clinical factors associated with achieving K/DOQI hemoglobin targets in hemodialysis patients

Background: Few studies have assessed treatable factors associated with achieving the Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline of hemoglobin values of 11 to 12 g/dL in anemic hemodialysis patients. Methods: This was a retrospective study of 30,029 prevalent hemodialysis patients with mean hemoglobin values less than 11 g/dL between January 1 and March 31, 1999. We studied the associations between demographic characteristics, comorbid conditions, disease severity, urea reduction ratio, epoetin doses, intravenous iron doses, and mean hemoglobin values in the ensuing 3 months. Results: Approximately half (51.3%) of patients reached a mean hemoglobin value of at least 11 g/dL. By multiple logistic regression, the major factors showing a positive association with this outcome included a urea reduction ratio greater than 75% (odds ratio [OR], 1.23; P < 0.0001) and intravenous iron (OR: for 0 vials/month, 1; for <1, 1.22; for 1 to 1.9, 1.36; 2 to 2.9, 1.48; for 3 to 3.9, 1.61; for ≥4, 1.79; P < 0.0001), while a negative association with hemoglobin response, possibly representing epoetin resistance, was shown for initial severity of anemia (OR: for initial hemoglobin value <7 g/dL, 0.06; for 7 to 7.9 g/dL, 0.12; for 8 to 8.9 g/dL, 0.23; for 9 to 9.9 g/dL, 0.45; for 10 to 10.9 g/dL, 1; P < 0.0001) and epoetin doses in the highest quintile (OR for >38,000 units/wk, 0.76; P < 0.0001). Conclusion: In patients with persistently low hemoglobin values, optimizing urea clearance and a proactive approach to intravenous iron therapy may enhance epoetin responsiveness.