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  • 1
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    Gender specific risk factors and outcomes of hyperkalemia in CKD patients: smoking as a driver of hyperkalemia in men
    Oxford University Press (OUP) ; 2023
    In:  Clinical Kidney Journal ( 2023-10-09)
    Details
    In: Clinical Kidney Journal, Oxford University Press (OUP), ( 2023-10-09)
    Abstract: Hyperkalemia is common among patients with chronic kidney disease (CKD) but there is scarce information on differential risk factors and outcomes for men and women. For instance, smoking has been suggested to be a risk factor for hyperkalemia, but specific analysis of the sex-specific impact of smoking on hyperkalemia in CKD are lacking. Methods We studied serum potassium levels in 2891 participants from the NEFRONA cohort: 483 controls (47% women) and 2408 CKD patients (38% women) without prior cardiovascular disease (CVD), assessing whether smoking is a risk factor for hyperkalemia, and if hyperkalemia is associated with outcomes separately for men and women. Results Median potassium levels and prevalence of hypo and hyperkalemia were higher in CKD participants than in controls. Serum potassium levels were higher and hyperkalemia and severe hyperkalemia more prevalent in men than in women with non-dialysis CKD (G3-G5). The highest prevalence of hyperkalemia for each gender was found in CKD G4-G5 and hemodialysis patients for men (46%) and in hemodialysis (54%) for women. Gender-specific etiological multivariate analysis identified current smoking as a risk factor for hyperkalemia only in men. Hyperkalemia was independently associated with stopping RAASi, an outcome which was more common in women. Hyperkalemia was also associated to higher risk of cardiovascular events within 4 years in men. Conclusions In conclusion, hyperkalemia is common among men and women with CKD, but the prevalence, risk factors and outcomes may differ by gender. Specifically, current smoking is a driver of hyperkalemia in men.
    Type of Medium: Online Resource
    ISSN: 2048-8505 , 2048-8513
    URL: Article
    DOI: 10.1093/ckj/sfad212
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 2
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    Matrix Gla protein polymorphism rs1800802 is associated with atheroma plaque progression and with cardiovascular events in a chronic kidney disease cohort
    Oxford University Press (OUP) ; 2023
    In:  Clinical Kidney Journal ( 2023-10-10)
    Details
    In: Clinical Kidney Journal, Oxford University Press (OUP), ( 2023-10-10)
    Abstract: Chronic kidney disease (CKD) is associated with increased atherosclerotic burden and higher risk for cardiovascular events (CVE). Atherosclerosis has a significant genetic component and, in CKD, it is influenced by mineral metabolism alterations. Therefore, genetic modifications of mineral metabolism-related proteins could affect atherosclerosis in CKD patients. In the present study we investigated the role of single nucleotide polymorphisms (SNPs) of the matrix gamma-carboxy glutamic acid protein (MGP) on atherosclerosis progression and CVE in a CKD cohort. Methods 2,187 CKD patients from the NEFRONA study were genotyped for SNPs present in the MGP gene. Atheromatosis was detected by vascular ultrasound. Progression of atheromatosis, defined as an increase in territories with plaque, was assessed after 24 months. Patients were followed for 48 months for CVE. Association of SNPs with plaque progression was assessed by logistic regression and their capacity to predict CVE by Cox regression. Results Three SNPs of the MGP gene were analyzed. No association of the rs4236 or the rs1800801 SNPs was detected with any of the outcomes. However, patients homozygotes for the minor allele of the rs1800802 SNP showed higher adjusted risk for plaque progression (Odds Ratio (OR) 2.3 [95% confidence interval (CI) 1.06-4.9]), and higher risk of suffering a CVE (hazard ratio (HR) 2.16 [95% confidence interval (CI) 1.13-4.12] ) compared with the rest of genotypes. No association of the SNP with total or dp-ucMGP levels was found in a subsample. Conclusions The rs1800802 polymorphisms of MGP is associated with plaque progression and cardiovascular events in CKD patients.
    Type of Medium: Online Resource
    ISSN: 2048-8505 , 2048-8513
    URL: Article
    DOI: 10.1093/ckj/sfad257
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 3
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    #5864 EFFECT OF IV FERRIC CARBOXYMALTOSE ON PHYSICAL PERFORMANCE AND QOL IN PATIENTS WITH CKD NOT ON DIALYSIS, MILD ANEMIA AND IRON DEFICIENCY
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. Supplement_1 ( 2023-06-14)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Abstract: Iron deficiency (ID) in patients with chronic kidney disease (CKD) is highly prevalent and contributes to a poorer quality of life. According to current guidelines, treatment with intravenous (IV) iron is limited to CKD patients with ID and anemia to avoid/delay the use of erythropoiesis-stimulating agents (ESAs) or the reduce the doses of ESA in patients treated with these drugs. Considering the effects of the correction of ID in other settings, we hypothetized that treatment with IV iron in patients with ID and borderline anemia can improve physical performance and their quality of life, independent of the effects on hemoglobin. Method Prospective, unicentric, single-arm study in CKD patients with ID, mild anemia and with-out heart failure. The inclusion criteria were: age ≥ 18 years, CKD patients stages 3–5 not on dialysis, iron deficiency (ferritin & lt;100 ng/ml or ferritin & lt;200 ng/ml if TSAT & lt;20%), mild anaemia (Hb 10.5-11.5 g/dL). At the baseline visit, after all the studies were performed, iv ferric carboxymaltose was administered in a single dose, according to the degree of ID calculated by the Ganzoni´s formula. The co-primary outcome was the change in physical performance, evaluated through the 6 minute-walk test (6MWT) at one week and at four weeks. Secondary end-points: Patient's global assessment (PGA) and quality of life (EQ-5D), Piper's fatigue test, serum phosphorous at four week. Laboratory data, PGA, EQ-5D and Piper test questionnaires were evaluated at baseline, and at weeks 1 and 4 after receiving IV ferric carboximaltose. Results 41 patients completed the study. Primary end-point: the 6MWT increased significantly from 296 ± 101 m to 314 ± 106 m at week 1 (p & lt;0.01), and to 325 ±111 meters at week 4 (p & lt;0.01). at week 4 (p = 0.083). A significant improvement in the PGA test values was detected when compared baseline vs 4 weeks (adjusted p value = 0.031). No significant differences were found between the baseline and week 1 (adjusted p value = 0.083), and week 1 and week 4 visits (adjusted p value = 0.086). No significant differences were found between the initial, 1-week, and 4-week visits in the EQ-5D quality of life questionnaire nor Piper's fatigue test. Phosphorus levels decreased significantly at week 1 from baseline (3.16 ± 0.7 vs 3.72 ± 0.6) (adjusted p & lt;0.001), with a partial recovery of serum levels in week 4 (3.57 ± 0.7 mg/dL). There were no significant increases in hemoglobin concentration between the different time periods. Conclusion IV ferric carboximaltose administration significantly improved the functional capacity of CKD patients with ID in short term. PGA also improved slightly but significantly. Effects that were independent of hemoglobin changes, suggesting a role of ID for a lower physical performance in CKD patients without heart failure, independent of the presence of anemia.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad063c_5864
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 4
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    #2695 THE ENVIRONMENTAL IMPACT OF CHRONIC KIDNEY DISEASE INTERNATIONALLY: RESULTS OF A LIFE CYCLE ASSESSMENT
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. Supplement_1 ( 2023-06-14)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Abstract: The environmental impact of healthcare is high, and kidney care for chronic kidney disease (CKD) contributes significantly to this. Haemodialysis represents the only viable kidney replacement option for certain patients with CKD, in whom the clinical benefits are lifesaving. Haemodialysis is also resource-intensive, requiring frequent sessions, and energy- and water-intensive equipment. In recognition of this, the ERA has implemented a green nephrology initiative aiming to minimize the environmental impact of kidney care. However, there is a paucity of up-to-date analysis on the environmental impact of different dialysis techniques and CKD overall. This study presents an international, holistic life cycle assessment (LCA) of the environmental impact of CKD in adults at all CKD stages. Method LCA methodology was used, conducted according to ISO 14040/14044 international standards, to estimate the annual environmental impacts of each stage (1–5) of CKD per patient. At CKD Stage 5, supportive care, haemodialysis, peritoneal dialysis, and transplantation pathways were considered. A literature review was performed to identify all studies reporting healthcare resource use in CKD, stratified by CKD stage. The study boundary is summarised in Figure 1. GaBi software was used to model the pathway based on ecoinvent Life Cycle Inventory database version 3.8. Environmental impact categories were reported according to the impact assessment methods, ReCiPE 2016 v1.1 and TRACI 2.1 (US only). Here, we describe the preliminary analysis of the international study, presenting results on the annual environmental impact of in-centre haemodialysis in the UK, based on one patient receiving haemodialysis three times weekly for four hours per session. The inputs for in-centre haemodialysis comprised dialysis consumables and their transport, energy/water used by the haemodialysis machine (including reverse osmosis), heating/cooling/lighting of the healthcare area, waste disposal, and patient transport. Results A total of 93,600 litres of water and 3,058 kWh electricity was estimated per patient for in-centre haemodialysis annually in the UK. The carbon footprint of in-centre haemodialysis in the UK per patient was estimated to be 3,900 kg CO2 equivalents, comparable to the average UK persons annual greenhouse gas footprint, effectively doubling their yearly greenhouse gas impact. Several other environmental impact categories were measured beyond the carbon footprint, including photochemical oxidation potential (ground-level ozone formation) and fine particulate matter, measured as PM2.5. Across each impact category, the parameters that drove each environmental impact differed (Figure 2). For example, dialysis consumables, haemodialysis machine, and patient transport were the main environmental contributors of fine particulate matter, while patient transport was the main driver of terrestrial ecotoxicity. Conclusion The results of this LCA build upon previous published research and demonstrate a high carbon footprint for in-centre haemodialysis, in line with other studies. The results also show that the environmental impact of in-centre haemodialysis goes beyond that of its carbon footprint, to other important environmental aspects such as PM2.5 emissions, in which long-term exposure is associated with health problems, such as cardiovascular and respiratory diseases, and an increased risk of CKD. This study hopes to highlight the need for evidence-based policy interventions around the implementation of green nephrology initiatives such as use of renewable energy to power haemodialysis, utilisation of water conserving reverse osmosis systems, and reduction in waste. Furthermore, healthcare policy initiatives that could help detect patients in the early stages of CKD and thereby enable them to be managed proactively could eventually reduce the need for resource-intensive dialysis therapy.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad063c_2695
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 5
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    MO535: Associations of Haemoglobin Values and Rate of Changes With MACE in the ASCEND-ND Randomised Clinical Trial
    Oxford University Press (OUP) ; 2022
    In:  Nephrology Dialysis Transplantation Vol. 37, No. Supplement_3 ( 2022-05-03)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 37, No. Supplement_3 ( 2022-05-03)
    Abstract: Rapid changes in haemoglobin (Hb) following treatment with erythropoiesis-stimulating agents (ESAs) in patients with anaemia of chronic kidney disease (CKD) have been suggested to be associated with adverse outcomes [1–3]. This exploratory post-hoc analysis was performed to investigate the association between absolute Hb values or Hb changes over a 4-week period and the occurrence of first adjudicated major adverse cardiovascular event (MACE) in CKD patients not on dialysis who were treated with either daprodustat or darbepoetin. METHOD ASCEND-ND was an event driven, cardiovascular outcomes trial conducted in over 30 countries that randomized 3872 CKD patients not on dialysis with baseline Hb of 8–10 g/dL if not on a prior ESA, or 8–11 g/dL if receiving an ESA, to receive either oral, once-daily daprodustat (1937 patients) or subcutaneous darbepoetin (1935 patients). Available doses were daprodustat 1–24 mg once-daily and darbepoetin 20–400 µg total 4-weekly dose. The study was recently reported to have met the co-primary endpoints of non-inferiority for first occurrence of adjudicated MACE and mean Hb change from baseline to weeks 28 through 52 [4]. MACE was a composite of death from any cause, non-fatal myocardial infarction or non-fatal stroke, and events were adjudicated by an independent clinical events committee blinded to treatment assignment. In this exploratory post-hoc analysis, we examined the associations of post-randomization absolute Hb values and Hb changes categorized into quintiles (see Table 1) with first adjudicated MACE. Each patient's time in the study, prior to a first MACE or end of follow-up, was divided into distinct 4-week intervals, with each interval associated with a particular post-randomization Hb value and rate of change. Separately for each treatment group, these 4-week periods were grouped according to quintiles of Hb values, and MACE rates were calculated for each quintile. This analysis was repeated using quintiles derived from Hb rate of decrease and increase. MACEs that occurred prior to Week 4, the first scheduled post-randomization Hb collection, were not included in the analysis. RESULTS This analysis included 371 and 361 first occurrences of adjudicated MACE (‘first MACE’) in the daprodustat and darbepoetin treatment groups, respectively. When evaluating the rate of first MACE by absolute Hb value quintiles and irrespective of Hb change (‘All’ column in Figure 1), the MACE rate was higher in the low Hb quintile than in the high Hb quintile for both treatment groups (Figure 1). Evaluating the rate of first MACE by Hb change quintile and irrespective of absolute Hb value (‘All’ row in Figure 1), the rates of MACE were comparable across Hb change quintiles within each treatment group. When MACE risk was evaluated by both absolute Hb value and Hb change quintiles, the highest MACE rate was observed in the lowest Hb quintile (Q1 row) with the largest positive change (Q5 increase column), and this was more pronounced in the darbepoetin group. CONCLUSION This exploratory analysis suggests a possible association between Hb quintile and MACE outcome for both absolute and fluxes in Hb values. However, this analysis has several limitations including a small number of events in each quintile, possible confounding by severity of disease, and the choice of assessment window. Further studies will be needed to confirm these findings.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfac072.017
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 6
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    #3704 EU REGION-SPECIFIC CARDIOVASCULAR EVENT DATA FOR DAPRODUSTAT IN ASCEND-D AND ASCEND-ND
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. Supplement_1 ( 2023-06-14)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Abstract: Daprodustat (GSK1278863) is a hypoxia-inducible factor prolyl hydroxylase inhibitor under investigation for the treatment of anaemia of chronic kidney disease. Phase 3 studies in dialysis (ASCEND-D) and non-dialysis (ASCEND-ND) patients demonstrated the non-inferiority of daprodustat vs recombinant human erythropoietin (rhEPO) control (in ASCEND-D) or darbepoetin alfa (ASCEND-ND) control in terms of the mean change in haemoglobin levels between Weeks 28 and 52 versus baseline and the first occurrence of a composite major adverse cardiovascular (CV) event (MACE) [1, 2]. Post-hoc analyses were conducted to evaluate prespecified CV endpoints for patients enrolled in these studies from participating countries in Europe (EU patients) versus elsewhere (non-EU patients). Method Post-hoc time to the first adjudicated MACE (death from any cause, non-fatal myocardial infarction or non-fatal stroke), time to the first adjudicated MACE or thromboembolic event (TEE; deep vein thrombosis, pulmonary embolism or vascular access thrombosis), and time to the first adjudicated MACE or hospitalisation for heart failure (HHF) were analysed for EU (enrolled from Austria, Belgium, Bulgaria, Czech Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Romania, Spain, Sweden and the UK; not all countries participated in both studies) and non-EU (all other participating countries) patients. Hazard ratios (HRs) and associated 95% confidence intervals were calculated to evaluate the likelihood of CV events with daprodustat versus alternative therapy in both studies. HRs for EU and non-EU patients were compared for each endpoint in each study and p-values were calculated to assess the statistical significance of observed differences. Significance was defined at the 10% level (interaction p-value & lt;0.1). Results ASCEND-D included 415 EU patients and 1072 non-EU patients randomised to daprodustat, and 440 EU and 1037 non-EU patients randomised to rhEPO. ASCEND-ND included 410 EU patients and 1527 non-EU patients randomised to daprodustat, and 407 EU and 1528 non-EU patients randomised to darbepoetin alfa. No significant heterogeneity was observed between EU and non-EU patients in terms of the prespecified CV endpoints (p≥0.1979). In ASCEND-D and ASCEND-ND, the results for MACE, MACE+TEE and MACE+HHF for the EU subgroup were consistent with the non-EU subgroup (Table), as well as with the co-primary analysis [1, 2]. Efficacy and additional safety data for EU versus non-EU patients are being explored and will be included in the subsequent presentation. Conclusion Non-inferiority in terms of the first occurrence of MACE was demonstrated for daprodustat versus rhEPO in ASCEND-D and versus darbepoetin alfa in ASCEND-ND.1,2 Results for EU and non-EU patients in the current analysis were consistent with the global outcomes from both studies.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad063c_3704
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 7
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    MO534: Associations of Haemoglobin Values and Rate of Changes With Mace in the ASCEND-D Randomised Clinical Trial
    Oxford University Press (OUP) ; 2022
    In:  Nephrology Dialysis Transplantation Vol. 37, No. Supplement_3 ( 2022-05-03)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 37, No. Supplement_3 ( 2022-05-03)
    Abstract: Preliminary analyses suggest that absolute haemoglobin (Hb) values and rapid Hb changes may be associated with adverse outcomes in patients with anaemia of chronic kidney disease (CKD) treated with erythropoiesis-stimulating agents (ESAs) [1–3]. In this exploratory post-hoc analysis of the ASCEND-D trial, we investigated the association between absolute Hb values or Hb changes over 4-week periods and the occurrence of the first adjudicated major adverse cardiovascular event (MACE) in patients with CKD on dialysis who were treated with either daprodustat or ESAs. METHOD ASCEND-D was an event-driven cardiovascular outcomes trial conducted in over 30 countries that randomized 2964 CKD patients undergoing dialysis with a baseline Hb of 8.0–11.5 g/dL to receive oral, once-daily daprodustat (1487 patients), or a conventional ESA (epoetin alfa or darbepoetin; 1477 patients). Available doses were daprodustat 1–24 mg once-daily, epoetin alfa 1500–60 000 U total weekly dose, and darbepoetin 20–400 µg total 4-weekly dose. The co-primary endpoints of non-inferiority for first occurrence of adjudicated MACE and mean Hb change from baseline to weeks 28 through 52 were met and have been reported recently [4] . MACE was a composite of death from any cause, non-fatal myocardial infarction or non-fatal stroke. An independent clinical events committee, blind to treatment assignment, adjudicated the events. To examine the association of post-randomization absolute Hb values and Hb changes with first adjudicated MACE, we divided each patient's time in the study before a first MACE or end of follow-up into distinct 4-week intervals. We then calculated a post-randomization mean Hb value and Hb rate of increase or decrease at each 4-week interval. Separately for each treatment arm, we grouped these 4-week periods into quintiles of mean Hb values and Hb rates of increase or decrease (see Table 1), and calculated MACE rates for each quintile. This analysis did not include MACE that occurred before Week 4, as this was the time for the first scheduled post-randomization Hb collection. We used the average of Hb values imputed by the multiple imputation method to impute missing Hb values. RESULTS This analysis included 361 and 389 first MACE in the daprodustat and ESA treatment groups, respectively. When evaluating rates of the first occurrence of adjudicated MACE by absolute Hb value quintiles and irrespective of Hb change (‘All’ column in Figure 1), the MACE rate was higher in the low Hb quintile than in the high Hb quintile across both treatment groups. In the evaluation of rates of the first MACE by Hb change quintile and irrespective of absolute Hb value (‘All’ row in Figure 1), rates of MACE were comparable across Hb change quintiles within each treatment group. When MACE risk was evaluated by both absolute Hb value and Hb change quintiles, the highest MACE rate was observed in the lowest Hb quintile (Q1 row) with the largest positive change (Q5 increase column), and this was more pronounced in the ESA group. CONCLUSION This exploratory analysis suggests a possible association between Hb quintile and MACE outcome for both absolute and fluxes in Hb values. However, this analysis has several limitations including a small number of events in each quintile, possible confounding by severity of disease and the choice of assessment window. Further studies are needed to confirm these findings.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfac072.016
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 8
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    #4445 ANAEMIA MANAGEMENT IN PERITONEAL DIALYSIS: FROM GUIDELINES TO ROUTINE CLINICAL PRACTICE
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. Supplement_1 ( 2023-06-14)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Abstract: The evidence on the management of renal anemia in peritoneal dialysis (PD) is much weaker than in hemodialysis (HD). Current guidelines establish the same haemoglobin (Hb) target for patients under eritropoietin stimulating agents (ESAs) in both dialysis techniques (PD, HD), although patients in PD are usually younger, more active and lesss comorbid. Unfortunately, there is not randomized controlled trials evaluating the efficacy and safety the effect of different Hb target on clinical outcomes. The aim is to describe the current situation of anaemia prevalence, treatments, and achievement of clinical guidelines recommendations in this population. Method Retrospective nationwide multicenter study including patients from 19 PD units. All prevalent PD patients that were active in the technique in November 2019 for at least 3 months was included (to avoid COVID pandemic interferences). Exclusion criteria were a previous kidney transplant failure and being on PD due to a cardiorenal syndrome with a residual renal function over 20 ml/min/1.73 m2. The nephrologists collected baseline data, demographics, comorbidities, and data related to anemia management (ie, laboratory values, previously prescribed treatments, and subsequent adjustments) from electronic medical records. The European adaptation of KDIGO guidelines was the reference for iron and Hb limits, prescriptions and targets. Results A total of 343 patients (mean age 62.9 years, 61.2% male) were included. Regarding anaemia-treatment prescription, 72.9% were receiving ESAs and 33.2% iron therapy (20.7% intravenously-IV and 12.5% orally). Eighty-two (32.8%) patients were receiving ESA without iron therapy, despite to have an indication to do it according ERBP guidelines in 53 out of them. After knowing lab results, iron therapy was only started in 8 (15%) patients. Among ESA-treated patients, 58.8% had an optimal control (Hb 10–12 g/dl). Seventeen patients had haemoglobin over 13 g/dl, and 12 of them continued receiving ESA after knowing lab results. Only three patients had persistent haemoglobin & lt;10 g/dl. Seven patients (2%) met criteria for ESA resistance (epoetin dose & gt;300 IU/kg/week). Patients in the highest tertile of erythropoietin resistance index (ERI) ( & gt;6.3 UI/kg/week/g/dl) were more inflamed, had lower albumin levels and lower residual renal function. Conclusion Anaemia prevalence is high in this population and its management in PD Units could be improved according to the ERBP guidelines. The lack of iron therapy in patients who should have received it and the excessive tolerance to high Hb levels are the most relevant opportunities to improve compliance with clinical guidelines.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad063c_4445
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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