Renal anemia: comparing current Eastern and Western European management practice (ORAMA)

The Optimal Renal Anaemia Management Assessment trial prospectively examined the impact of implementing European Best Practice Guidelines on outcomes in the management of renal anemia. Baseline data give an insight to standards of clinical care and provide a basis for a future comparison of guideline target attainment with final results. Fifty-three centers from eight European countries enrolled 739 patients with stage II-V chronic kidney disease who were either anemic (hemoglobin <11 g/dL) or treated with erythropoiesis-stimulating agents and/or iron supplementation. Patients were followed over 6-8 months in centers that were randomly allocated to either group A or B (i.e., with or without a computerized clinical decision support tool after baseline). The latter provided guideline-based recommendations to physicians based on patient anemia-related data. We report patient characteristics and hemoglobin values from baseline and the prestudy period, focusing on regional differences. In all, 81% of patients were dialysis-dependent. Baseline mean hemoglobin values in dialysis patients were significantly higher in Western (11.8 g/dL) vs. Eastern Europe (10.6 g/dL; p < 0.0001). Similar proportions of patients (approximately 50%) had mean hemoglobin 10-12 g/dL suggesting Eastern European patients are treated to lower Hb levels. The guideline ferritin target was achieved by 85% of dialysis and 52% of non-dialysis patients; 81% of dialysis and 78% of non-dialysis patients attained the transferrin saturation target. Most patients (96%) were receiving erythropoiesis-stimulating agents. Anemia management in patients with chronic kidney disease shows considerable regional differences across Europe, and target attainment remains suboptimal in many European nephrology centers after the revised 2004 guidelines.