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Current clinical profiles for Chinese hemodialysis patients
Xinju Zhao1, Chengqian Ma1, Liangying Gan1
1Department of Nephrology, Peking University People's Hospital, Unit 10C in Ward Building, 11 Xizhimennan Street, Xicheng District, Beijing, 100044, China.
Insights
This study analyzed hemodialysis patients in China, revealing improvements in key indicators like hemoglobin and phosphorus since DOPPS5. However, lower albumin levels were observed, highlighting areas for continued focus in patient care.
Area of Science:
- Nephrology
- Clinical Epidemiology
- Public Health
Background:
- The increasing prevalence of hemodialysis (HD) patients in China necessitates understanding their clinical profiles.
- The China Dialysis Outcomes and Practice Patterns Study (DOPPS) provides crucial data on HD patient care.
- Comparing current data with previous phases helps track trends and identify areas for improvement.
Purpose of the Study:
- To analyze the baseline clinical characteristics of hemodialysis patients in China participating in DOPPS Phase 7 (DOPPS7).
- To assess current target ranges for key laboratory and clinical parameters in Chinese HD patients.
- To compare findings from DOPPS7 with those from DOPPS Phase 5 (DOPPS5).
Main Methods:
- Analysis of baseline data from 1843 patients enrolled in the China DOPPS7.
- Collection and reporting of demographic, clinical, laboratory, and vascular access data.
- Comparison of DOPPS7 data with historical data from DOPPS5.
Main Results:
- The study population had a mean age of 61 years, with 60.7% males. Leading causes of end-stage kidney disease (ESKD) were diabetes (31.7%) and chronic glomerulonephritis (21.4%).
- High proportions met targets for Kt/V (81.2%) and albumin >3.5 g/dl (80.5%). However, only 44.2% met hemoglobin targets, 63.8% met calcium targets, and 38.3% met phosphate targets.
- Improvements were noted in hemoglobin, phosphorus, iPTH, and spKTV compared to DOPPS5, but serum calcium, TSAT, and ferritin remained stable, with an increase in patients having albumin <3.5 g/dl.
Conclusions:
- While some indicators have improved since DOPPS5, achieving target ranges for hemoglobin, calcium, and phosphate remains a challenge for Chinese hemodialysis patients.
- The study highlights regional variations in patient characteristics and care, emphasizing the need for tailored interventions.
- Further research is needed to address the increase in low albumin levels and understand the conditions in smaller cities and remote areas.
Abstract:
The prevalence of hemodialysis (HD) patients in China is escalating, necessitating a comprehensive understanding of their clinical profiles. This study offers an in-depth analysis of the baseline data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS) Phase 7 (DOPPS7), aiming to assess the current clinical characteristics and target ranges for the most recent years. It also compares these findings with those from DOPPS Phase 5. The DOPPS is a well-regarded international, prospective, and observational cohort study. Our analysis focused on the initial sample of patients enrolled in China DOPPS7. We report the demographic and clinical characteristics of 1843 patients, with a mean age of 61 ± 14 years and a male predominance (60.7%). The median dialysis vintage was 2.64 years, with diabetes (31.7%) and chronic glomerulonephritis (21.4%) being the leading causes of end-stage kidney disease (ESKD). Notably, 81.2% of patients had a single-pooled Kt/V ≥ 1.2, and 80.5% maintained albumin levels > 3.5 g/dl. Hemoglobin levels within the target range (110-130 g/dl) were observed in 44.2% of patients, while serum calcium (8.4-10.2 mg/dl) and phosphate (3.5-5.5 mg/dl) were within target ranges in 63.8% and 38.3% of patients, respectively. PTH levels were maintained within 150-600 pg/dl in 57.6% of patients, and 84.7% utilized fistula as their vascular access. Significant variations were noted in demographic, clinical, laboratory, and treatment characteristics among the three cities involved in the study. Compared to DOPPS5, improvements were observed in the proportion of patients meeting standards for hemoglobin, blood phosphorus, iPTH, and spKTV, while serum calcium, TSAT, and ferritin levels remained relatively stable. However, an increase in the proportion of patients with albumin < 3.5 g/dl was noted. The study's limitations include the exclusion of patients from smaller cities and remote areas, where HD patient conditions might differ significantly from those reported.
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