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Quality of care and practice patterns in anaemia management at specialist kidney clinics in Ireland: a national study

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Show simple item record Stack, Austin G. Alghali, Ahmed Li, Xia Ferguson, John P. Casserly, Liam F. Cronin, Cornelius J. Reddan, Donal N. Hussein, Wael F. Elsayed, Mohamed E. 2017-07-19T07:30:08Z 2017-07-19T07:30:08Z 2017
dc.description peer-reviewed en_US
dc.description.abstract Background: Although anaemia is a common complication of advanced chronic kidney disease (CKD), knowledge of quality of care and management practices in specialist clinics varies. We examined anaemia practices at specialist nephrology clinics within the Irish health system and evaluated the opinions of practicing nephrologists. Methods: A multicentre cross-sectional study was conducted at specialist nephrology clinics across six geographic regions in Ireland. Clinical characteristics and treatment practices were evaluated in a sample of 530 patients with CKD. An accompanying national survey questionnaire captured opinions and treatment strategies of nephrologists on anaemia management. Results: The prevalence of anaemia [defined as haemoglobin (Hb)<12.0 g/dL] was 37.8%, which increased significantly with advancing CKD (from 21% to 63%; P<0.01) and varied across clinical sites (from 36% to 62%; P<0.026). Iron deficiency (ID) was present in 46% of all patients tested and 86% of them were not on treatment. More than 45% of anaemic patients were not tested for ID. Respondents differed in their selection of clinical guidelines, threshold targets for erythropoiesis-stimulating agent (ESA) and intravenous iron therapy and anaemia management algorithms were absent in 47% of the clinics. The unexpectedly low rates of ESA use (4.7%) and iron therapy (10.2%) in clinical practice were in contrast to survey responses where 63% of nephrologists indicated ESA therapy initiation when Hb was<10.0 g/dL and 46% indicated commencement of iron therapy for ferritin<150 ng/mL. Conclusion: This study highlights substantial variability in the management of anaemia and ID at specialist nephrology clinics with low testing rates for ID, high rates of anaemia and ID and underutilization of effective treatments. Variability in the adoption and implementation of different clinical guidelines was evident. en_US
dc.language.iso eng en_US
dc.publisher Oxford University Press en_US
dc.relation.ispartofseries Clinical Kidney Journal;pp. 1-9
dc.rights This article was published in Clinical Kidney Journal 2017, pp. 1-9, en_US
dc.subject chronic kidney disease en_US
dc.title Quality of care and practice patterns in anaemia management at specialist kidney clinics in Ireland: a national study en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1093/ckj/sfx060
dc.contributor.sponsor HRB en_US
dc.relation.projectid HRA-2013-PHR-685 en_US
dc.relation.projectid HRA-2013-PHR-437 en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 2741315

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