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  • Measure Summary
  • NQMC:000335
  • Oct 2002

Advanced chronic kidney disease (CKD): percent of patients with blood pressure checked at every erythropoietin or analogue dose.

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in March 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure assesses the percent of patients with blood pressure checked at every erythropoietin or analogue dose among patients with advanced chronic kidney disease (CKD) who are receiving erythropoietin or analogue.

Rationale

Anemia is common in patients with advanced chronic kidney disease (CKD) and can lead to a variety of detrimental effects. In addition to the direct effects of anemia on performance and ischemic symptoms, it has also been suggested that mortality and major complications during end-stage renal disease (ESRD) are associated with anemia that develops early in the course of CKD. Correcting anemia before the initiation of renal replacement therapy (RRT) may improve health outcomes.

Blood pressure control often deteriorates with erythropoietin therapy. Seven small studies suggest at least some increase in the risk of developing hypertension or of suffering an exacerbation of hypertension associated with erythropoietin therapy.

Evidence for Rationale

Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the third National Health and Nutrition Examination Survey (1988-1994) [in press]. Ann Intern Med. Unknown;.

Blair SD, Janvrin SB, McCollum CN, Greenhalgh RM. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg. 1986 Oct;73(10):783-5. PubMed External Web Site Policy

Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409-17. PubMed External Web Site Policy

Holland DC, Lam M. Predictors of hospitalization and death among pre-dialysis patients: a retrospective cohort study. Nephrol Dial Transplant. 2000 May;15(5):650-8. PubMed External Web Site Policy

Howard AD, Moore J Jr, Welch PG, Gouge SF. Analysis of the quantitative relationship between anemia and chronic renal failure. Am J Med Sci. 1989 May;297(5):309-13. [58 references] PubMed External Web Site Policy

Hsu CY, Bates DW, Kuperman GJ, Curhan GC. Relationship between hematocrit and renal function in men and women. Kidney Int. 2001 Feb;59(2):725-31. PubMed External Web Site Policy

Kamper AL, Nielsen OJ. Effect of enalapril on haemoglobin and serum erythropoietin in patients with chronic nephropathy. Scand J Clin Lab Invest. 1990 Oct;50(6):611-8. [110 references] PubMed External Web Site Policy

Kazmi WH, Kausz AT, Khan S, Abichandani R, Ruthazer R, Obrador GT, Pereira BJ. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis. 2001 Oct;38(4):803-12. PubMed External Web Site Policy

Kleinman KS, Schweitzer SU, Perdue ST, Bleifer KH, Abels RI. The use of recombinant human erythropoietin in the correction of anemia in predialysis patients and its effect on renal function: a double- blind, placebo-controlled trial. Am J Kidney Dis. 1989 Dec;14(6):486-95. [86 references] PubMed External Web Site Policy

Lim VS, DeGowin RL, Zavala D, Kirchner PT, Abels R, Perry P, Fangman J. Recombinant human erythropoietin treatment in pre-dialysis patients. A double-blind placebo-controlled trial. Ann Intern Med. 1989 Jan 15;110(2):108-14. [37 references] PubMed External Web Site Policy

McClellan WM, Owen WF. Preliminary results of the Prevalence of Anemia in Patients with Early Renal Insufficiency (PAERI) Study [abstract]. J Am Soc Nephrol. 2001;A1173.

McGonigle RJ, Wallin JD, Shadduck RK, Fisher JW. Erythropoietin deficiency and inhibition of erythropoiesis in renal insufficiency. Kidney Int. 1984 Feb;25(2):437-44. PubMed External Web Site Policy

Moudgil A, Bagga A. Evaluation and treatment of chronic renal failure. Indian J Pediatr. 1999 Mar-Apr;66(2):241-53. [38 references] PubMed External Web Site Policy

Portoles J, Torralbo A, Martin P, Rodrigo J, Herrero JA, Barrientos A. Cardiovascular effects of recombinant human erythropoietin in predialysis patients. Am J Kidney Dis. 1997 Apr;29(4):541-8. PubMed External Web Site Policy

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

Revicki DA, Brown RE, Feeny DH, Henry D, Teehan BP, Rudnick MR, Benz RL. Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients. Am J Kidney Dis. 1995 Apr;25(4):548-54. [42 references] PubMed External Web Site Policy

Seidenfeld J, Piper M, Flamm C, Hasselblad V, Armitage JO, Bennett CL, Gordon MS, Lichtin AE, Wade JL 3rd, Woolf S, Aronson N. Epoetin treatment of anemia associated with cancer therapy: a systematic review and meta-analysis of controlled clinical trials. J Natl Cancer Inst. 2001 Aug 15;93(16):1204-14. PubMed External Web Site Policy

Silverberg DS, Wexler D, Blum M, Keren G, Sheps D, Leibovitch E, Brosh D, Laniado S, Schwartz D, Yachnin T, Shapira I, Gavish D, Baruch R, Koifman B, Kaplan C, Steinbruch S, Iaina A. The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol. 2000 Jun;35(7):1737-44. PubMed External Web Site Policy

Strauss MJ, Port FK, Somen C, Wolfe RA. An estimate of the size of the US predialysis population with renal insufficiency and anemia. Am J Kidney Dis. 1993 Mar;21(3):264-9. PubMed External Web Site Policy

United States Renal Data System (USRDS), National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases. USRDS 1999 annual data report. Bethesda (MD): United States Renal Data System; 1999 Apr. 994 p.

Usuba T, Kuno T, Higuchi T, Kikuchi F, Nagura Y, Kanmatsuse K, Takahashi S. Effects of recombinant human erythropoietin (rHuEPO) on nutritional status of hemodialysis patients: investigation of direct anabolic effects of rHuEPO. Nippon Jinzo Gakkai Shi. 1994 Nov;36(11):1288-95. PubMed External Web Site Policy

Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med. 2001 Oct 25;345(17):1230-6. PubMed External Web Site Policy

Yamazaki C, Watanabe Y, Sakamoto N. Pharmacokinetic study of recombinant human erythropoietin treatment in pre-dialysis end stage renal disease patients. Nippon Jinzo Gakkai Shi. 1993 Nov;35(11):1233-42. PubMed External Web Site Policy

Primary Health Components

Advanced chronic kidney disease; anemia; erythropoietin; blood pressure monitoring

Denominator Description

The number of adult patients with advanced chronic kidney disease (CKD) for at least three months, not currently receiving renal replacement therapy who are receiving an erythropoietin or analogue

Numerator Description

The number of patients from the denominator with blood pressure checked at every erythropoietin or analogue dose

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)

Additional Information Supporting Need for the Measure

  • Two studies have identified anemia as being prevalent in patients with advanced chronic kidney disease and it is also clear that the severity of anemia increases considerably with worsening renal function.
  • Anemia is associated with increased mortality, detrimental effects on cardiac function, exercise capacity, quality of life, and cognitive function.

Evidence for Additional Information Supporting Need for the Measure

1999 Annual report: ESRD clinical performance measures project (formerly ESRD Core Indicators Project). Opportunities to improve care for adult in-center hemodialysis and adult peritoneal dialysis patients. Baltimore (MD): U.S. Department of Health and Human Services, Health Care Financing Administration Office of Clinical Standards and Quality; 1999 Dec.

Fink J, Blahut S, Reddy M, Light P. Use of erythropoietin before the initiation of dialysis and its impact on mortality. Am J Kidney Dis. 2001 Feb;37(2):348-55. PubMed External Web Site Policy

Kleinman KS, Schweitzer SU, Perdue ST, Bleifer KH, Abels RI. The use of recombinant human erythropoietin in the correction of anemia in predialysis patients and its effect on renal function: a double- blind, placebo-controlled trial. Am J Kidney Dis. 1989 Dec;14(6):486-95. [86 references] PubMed External Web Site Policy

Lim VS, DeGowin RL, Zavala D, Kirchner PT, Abels R, Perry P, Fangman J. Recombinant human erythropoietin treatment in pre-dialysis patients. A double-blind placebo-controlled trial. Ann Intern Med. 1989 Jan 15;110(2):108-14. [37 references] PubMed External Web Site Policy

Madore F, Lowrie EG, Brugnara C, Lew NL, Lazarus JM, Bridges K, Owen WF. Anemia in hemodialysis patients: variables affecting this outcome predictor. J Am Soc Nephrol. 1997 Dec;8(12):1921-9. [49 references] PubMed External Web Site Policy

Obrador GT, Ruthazer R, Arora P, Kausz AT, Pereira BJ. Prevalence of and factors associated with suboptimal care before initiation of dialysis in the United States. J Am Soc Nephrol. 1999 Aug;10(8):1793-800. PubMed External Web Site Policy

Pickett JL, Theberge DC, Brown WS, Schweitzer SU, Nissenson AR. Normalizing hematocrit in dialysis patients improves brain function. Am J Kidney Dis. 1999 Jun;33(6):1122-30. PubMed External Web Site Policy

Portoles J, Torralbo A, Martin P, Rodrigo J, Herrero JA, Barrientos A. Cardiovascular effects of recombinant human erythropoietin in predialysis patients. Am J Kidney Dis. 1997 Apr;29(4):541-8. PubMed External Web Site Policy

Revicki DA, Brown RE, Feeny DH, Henry D, Teehan BP, Rudnick MR, Benz RL. Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients. Am J Kidney Dis. 1995 Apr;25(4):548-54. [42 references] PubMed External Web Site Policy

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Adult patients age 18 years and older with chronic kidney disease stage 4 or 5 (glomerular filtration rate [GFR] less than or equal to 30 mL/min/1.73 m2) for at least three months not currently receiving renal replacement therapy who are receiving an erythropoietin or analogue

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
The number of patients from the denominator who have their blood pressure checked at every erythropoietin or analogue dose

Exclusions
Unspecified

Numerator Search Strategy

Episode of care

Data Source

Administrative clinical data

Laboratory data

Paper medical record

Pharmacy data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Number of patients with blood pressure checked at every erythropoietin or analogue dose / number of patients receiving an erythropoietin or analogue.

Measure Collection Name

Clinical Performance Measures on Appropriate Patient Preparation for Renal Replacement Therapy

Measure Set Name

Anemia Recommendations

Submitter

Renal Physicians Association - Medical Specialty Society

Developer

Renal Physicians Association - Medical Specialty Society

Funding Source(s)

Ortho Biotech Products, LP

Composition of the Group that Developed the Measure

W. Kline Bolton, MD, Working Group Chair, University of Virginia School of Medicine, Charlottesville, VA; William F. Owen, Jr., MD, President, RPA, Duke University School of Medicine Durham, NC; Baxter Healthcare Corp., McGaw Park, IL; Dale Singer, MHA, Executive Director, RPA.

Content Experts: Jack Coburn, MD, UCLA School of Medicine, West Los Angeles V.A. Healthcare Center, West Los Angeles, CA; William Haley, MD, Mayo Clinic, Jacksonville, FL; Annamaria Kausz, MD, New England Medical Center, Boston, MA; Adeera Levin, MD, St. Paul's Hospital, Vancouver, BC; William Mitch, MD, University of Texas Medical Branch, Galveston, TX; Patricia Painter, PhD, University of California, San Francisco, CA; Michael Rocco, MD, MSCE, Wake Forest University School of Medicine, Winston-Salem, NC.

Association Representatives: Carolyn Atkins, RN, BS, CCTC, National Kidney Foundation, Medical City Dallas Hospital, Dallas, TX; Shelley Clark, RN, National Renal Administrators Association, FMC North Roanoke Dialysis, Roanoke, VA; Paul Eggers, PhD, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD; Lori Fedje, RD, LD, NKF Council on Renal Nutrition, Pacific Northwest Renal Services, Portland, OR; Richard Goldman, MD, Renal Physicians Association, Renal Medicine Associates, Emeritus Albuquerque, NM; Joel Greer, PhD, Centers for Medicare and Medicaid Services, Baltimore, MD; Richard Lafayette, MD, American Society of Nephrology, Stanford University School of Medicine, Stanford, CA; Eugene Z. Oddone, MD, American College of Physicians - American Society of Internal Medicine, Durham VA Medical Center, Durham, NC; Victoria Norwood, MD, American Society of Pediatric Nephrology, University of Virginia, Charlottesville, VA; Paul M. Palevsky, MD, Forum of ESRD Networks, University of Pittsburgh School of Medicine, VA Pittsburgh Health Care System, Pittsburgh, PA; Sandy Peckens, MSW, NKF Council of Nephrology Social Workers, Merrimack Valley Nephrology, Methuen, MA; Venkateswara Rao, MD, American Society of Transplantation, Hennepin County Medical Center, Minneapolis, MN; Charlotte Thomas Hawkins, PhD, RN, CNN, American Nephrology Nurses Association, Rutgers, The State University of New Jersey, Burlington, NJ; Joseph White, American Association of Kidney Patients.

Methodologists: David B. Matchar, MD, FACP, Director, Duke Center for Clinical Health Policy Research and Co-Director, Duke Evidence-based Practice Center, Durham, NC; Douglas C. McCrory, MD, MHS, Co-Director Duke Evidence-based Practice Center, Durham, NC; Joseph A. Coladonato, MD, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Preston S. Klassen, MD, MHS, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Meenal B. Patwardhan, MD, MHSA, Duke Center for Clinical Health Policy Research and Duke Evidence-based Practice Center, Durham, NC; Donal N. Reddan, MD, MHS, Duke Institute of Renal Outcomes Research & Health Policy, Durham, NC; Olivier T. Rutschmann, MD, MPH, Duke Center for Clinical Health Policy Research, Durham, NC; William S. Yancy, Jr., MD, MHS, Duke University Medical Center, Durham, NC.

Medical Editor: Rebecca N. Gray, DPhil, Duke Evidence-based Practice Center, Durham, NC.

Project Manager and Editor: Emily G. Shurr, MA, Duke Evidence-based Practice Center, Durham, NC.

Financial Disclosures/Other Potential Conflicts of Interest

There were none disclosed.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2002 Oct

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in March 2016.

Source(s)

Renal Physicians Association. Appropriate patient preparation for renal replacement therapy. Rockville (MD): Renal Physicians Association; 2002 Oct 1. 78 p. (Clinical Practice Guideline; no. 3).

Measure Availability

Source not available electronically.

For more information, contact the Renal Physicians Association (RPA) at 1700 Rockville Pike, Suite 220, Rockville, MD 20852; Phone: 301-468-3515; Fax: 301-468-3511; Web site: www.renalmd.org External Web Site Policy; E-mail: rpa@renalmd.org.

NQMC Status

This NQMC summary was completed by ECRI on May 2, 2003. The information was verified by the Renal Physicians Association on May 27, 2003.

This NQMC summary was retrofitted into the new template on May 5, 2011.

The information was reaffirmed by the measure developer on March 11, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, contact RPA at 1700 Rockville Pike, Suite 220, Rockville, MD 20852; phone: 301-468-3515; fax: 301-468-3511; Web site: www.renalmd.org External Web Site Policy; e-mail: rpa@renalmd.org.

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