adult peritoneal dialysis patients

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ESRD CLINICAL PERFORMANCE MEASURES PROJECTS36

uration of dialysis, and selected clinical param-ters are shown in Table 15. A higher percent ofen, Blacks, Hispanics, patients 18-44 years old,

atients with causes of ESRD other than diabetesellitus, and patients dialyzing 6 months or

onger had a mean serum albumin �4.0/3.7 g/dL40/37 g/L) (BCG/BCP) compared to women,

hites, non-Hispanics, patients older than 44ears, patients with diabetes mellitus as the causef ESRD, and patients dialyzing less than 6onths (Tables 15 and 16 and Figs 41 and 42).nly 16% of patients dialyzing less than 6 months

chieved an “optimal” serum albumin comparedo 38% of patients dialyzing 6 months or more.

Patients with higher mean hemoglobin andean spKt/V values had a mean serum albumin4.0/3.7 g/dL (40/37 g/L) (BCG/BCP) com-

ared to patients with lower mean hemoglobinnd mean spKt/V values. More patients dialyzedith either an AVF or an AV graft compared toatients dialyzed with a catheter had a meanerum albumin �4.0/3.7 g/dL (40/37 g/L) (BCG/CP) (43% and 37% versus 24% respectively)

Table 15).Nationally, 35% of patients had mean serum

lbumin �4.0/3.7 g/dL (40/37 g/L) (BCG/BCP)anging from 25% to 45% among the 18 Net-orks; 81% of patients had mean serum albumin3.5/3.2 g/dL (35/32 g/L) (BCG/BCP) ranging

rom 75% to 84% among the 18 Networks. Theercent of patients in each Network area, byender, race, ethnicity, age group and cause ofSRD, with mean serum albumin �4.0/3.7 g/dL

40/37 g/L) (BCG/BCP) is shown in Table 16.

. Findings for October-December 2002 Comparedo Previous Study Periods

No clinically important changes or improve-ents were noted in the proportion of adult

n-center hemodialysis patients with “adequate”r “optimal” serum albumin levels during Octo-er-December 2002 compared to previous studyeriods.Figure 43 shows the percent of patients withean serum albumin �4.0/3.7 g/dL (40/37 g/L)

BCG/BCP) and the percent of patients withean serum albumin values �3.5/3.2 g/dL (35/32

/L) (BCG/BCP) during October-December 2002
ompared to selected previous study periods. b
IV. ADULT PERITONEAL DIALYSIS PATIENTS

This section describes the findings for adulteritoneal dialysis patients for selected CPMsnd other quality indicators related to adequacyf peritoneal dialysis, anemia management, anderum albumin. Each of these sections is furtherroken down into 3 parts:(1) national findings for selected CPM results

or October 2002-March 2003 (the serum albu-in information is not considered a CPM for this

eport);(2) a description of other quality indicators or

ata analysis; and(3) a comparison of CPM and/or other indica-

ors or findings for October 2002-March 2003nd previous study periods.

A national random sample of adult (�18 years)eritoneal dialysis patients who were alive onecember 31, 2002, was selected (sample size �,436). 1,354 patients (94%) were included inhe sample for analysis.

A. ADEQUACY OF PERITONEAL DIALYSIS

. CPM Findings for October 2002-March 2003

Data to assess 3 peritoneal dialysis adequacyPMs were collected in 2003. The time period

rom which these data were abstracted was Octo-

Fig 43. Percent of adult in-center hemodialysis pa-ients with mean serum albumin >4.0/3.7 g/dL (BCG/CP)** and >3.5/3.2 g/dL (BCG/BCP), October-Decem-er 2002 compared to selected previous study periods.003 ESRD CPM Project.

er 2002-March 2003. Tidal peritoneal dialysis

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ADULT PERITONEAL DIALYSIS PATIENTS S37

atients (n � 30) were excluded from the perito-eal dialysis adequacy CPM calculations.Peritoneal Dialysis Adequacy CPM I—The

atient’s total solute clearance for urea and creat-nine is measured routinely (defined for thiseport as at least once during the 6-month studyeriod).FINDING: 88% of adult peritoneal dialysis

atients had both a weekly Kt/Vurea and a weeklyreatinine clearance measurement reported ateast once during the 6-month study period.

Peritoneal Dialysis Adequacy CPM II—Theatient’s total solute clearance for urea (weeklyt/Vurea) and creatinine (weekly creatinine clear-

nce) is calculated in a standard way. (See Perito-eal Dialysis Adequacy CPM II in Appendix 1.)FINDING: 65% of adult peritoneal dialysis

atients who had reported adequacy measure-ents documented in their chart at least once

uring the 6-month study period had these re-orted measurements (Kt/Vurea and creatininelearance) calculated in a standard way as de-cribed in Peritoneal Dialysis Adequacy CPM IIn Appendix 1.

Peritoneal Dialysis Adequacy CPM III—or patients on CAPD, the delivered peritonealialysis dose is a weekly Kt/Vurea of at least 2.0nd a weekly creatinine clearance of at least 60/wk/1.73 m2 OR there was evidence the dialysisrescription was changed if the adequacy mea-urements were below these thresholds duringhe 6-month study period.

For CCPD patients (cycler patients with aaytime dwell), the delivered peritoneal dialysisose is a weekly Kt/Vurea of at least 2.1 and aeekly creatinine clearance of at least 63 L/wk/.73 m2 OR there was evidence the dialysisrescription was changed if the adequacy mea-urements were below these thresholds duringhe 6-month study period.

For NIPD patients (cycler patients without aaytime dwell), the delivered peritoneal dialysisose is a weekly Kt/Vurea of at least 2.2 and aeekly creatinine clearance of at least 66 L/wk/.73 m2 OR there was evidence the dialysisrescription was changed if the adequacy mea-urements were below these thresholds duringhe 6-month study period.

FINDING: 71% of CAPD patients had a meaneekly Kt/Vurea �2.0 and a mean weekly creati-

2
ine clearance �60 L/wk/1.73 m OR there was t
vidence the dialysis prescription was changed ifhe adequacy measurements were below thesehresholds during the 6-month study period.

ALTERNATE FINDING: 79% (185/233) ofAPD patients with a Peritoneal Equilibrationest (PET) result within 12 months of or during

he study period met the revised 2000 NKF-/DOQI thresholds for peritoneal dialysis ad-

quacy33 (a mean weekly Kt/Vurea �2.0 and forigh and high-average transporters, a weeklyreatinine clearance �60 L/wk/1.73 m2, for lownd low-average transporters, a weekly creati-ine clearance �50 L/wk/1.73 m2, OR there wasvidence the dialysis prescription was changed ifhe adequacy measurements were below thesehresholds during the 6-month study period).

FINDING: 66% of cycler patients with a day-ime dwell (CCPD patients) had a mean weeklyt/Vurea �2.1 and a mean weekly creatinine

learance �63 L/wk/1.73 m2 OR there was evi-ence the dialysis prescription was changed ifhe adequacy measurements were below thesehresholds during the 6-month study period.

FINDING: 67% of cycler patients without aaytime dwell (NIPD patients) had a mean weeklyt/Vurea �2.2 and a mean weekly creatinine

learance �66 L/wk/1.73 m2 OR there was evi-ence the dialysis prescription was changed ifhe adequacy measurements were below thesehresholds during the 6-month study period.

. Other Peritoneal Dialysis Adequacy Findings forctober 2002-March 2003

There were 491 patients categorized as CAPDatients and 766 patients categorized as cycleratients during the study period. Tidal peritonealialysis patients (n � 30) were excluded fromhe peritoneal dialysis adequacy analyses re-orted below. By using values that were ab-tracted from medical records of peritoneal dialy-is patients, it was possible to calculate at least 1f the adequacy measures (weekly Kt/Vurea oreekly creatinine clearance) for 1,159 (88%) of

he 1,324 patients included for these analysesuring the 2003 study period.Table 17 depicts the percent of CAPD patients

y transporter type with a mean calculated weeklyt/Vurea and a mean calculated weekly creatinine

learance meeting recommended NKF-K/DOQIuidelines for those patients with sufficient data
o calculate adequacy measures.

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64% of cycler patients with a daytime dwellad a mean calculated weekly Kt/Vurea and9% had a mean calculated weekly creatininelearance that met recommended NKF-K/OQI guidelines during the 2003 study period

Table 18). 58% of cycler patients without aaytime dwell had a mean calculated weeklyt/Vurea and 56% had a mean calculated weekly

reatinine clearance that met recommendedKF-K/DOQI guidelines during the 2003 studyeriod.42% of patients (n � 551) had 1 or more PET

esults within 12 months of or during the studyeriod. The distribution of PET results is de-icted in Fig 44.

Table 17. Percent of Adult CAPD Patients With MeanGuidelines and Median Adequacy Values, by Transp

2003 ESR

Adequacy Measure

Oct 2000-Mar 2001

High-Avg/High* Low/Low-A

eekly Kt/Vurea

% meeting NKF-K/DOQI† 75% 71%Mean (�SD) 2.35 (�0.57) 2.35 (�0.5Median 2.26 2.32

eekly Creatinine Clearance(L/wk/1.73 m2)

% meeting NKF-K/DOQI 76% 79%Mean (�SD) 83.6 (�29.7) 73.0 (�27Median 78.6 68.5

*Transporter type (4 hr. D/P Cr Ratio): Low � 0.34igh � 0.82-1.02.†For CAPD patients, the delivered PD dose should be

/wk/1.73 m2 for high-average and high transporters, and �

Table 18. Percent of Adult Cycler Patients With MeanGuidelines and Median Adequacy Values, O

Adequacy Measure

Oct 2000-Mar 2001

With DaytimeDwell

No DaytimDwell

eekly Kt/Vurea

% meeting NKF-K/DOQI* 64% 53%Mean (�SD) 2.33 (�0.55) 2.33 (�0.7Median 2.24 2.22

eekly Creatinine Clearance% meeting NKF-K/DOQI 55% 61%

Mean (�SD) 71.9 (�25.6) 77.6 (�31.Median 65.7 75.3

*For nighttime cycler patients (no daytime dwell) (NIPD p
or cycler patients with daytime dwell (CCPD patients): Kt/Vurea �
33% of CAPD patients had a total prescriptionolume of 8000 mL and 31% had a total prescrip-ion volume of 10,000 mL (Fig 45).

33% of all cycler patients had a single night-ime dwell volume of 2,500 mL; 28% had aingle nighttime dwell volume of 2,000 mL (Fig6). 44% of all cycler patients had a mean of 4ighttime exchanges, 25% had a mean of 5ighttime exchanges, and another 12% had aean of 3 nighttime exchanges (Fig 47).12% (n � 91) of cycler patients did not have a

aytime dwell. 39% of cycler patients with aaytime dwell had a mean single daytime dwellolume of 2,000 mL; 22% had a mean singleaytime dwell volume of 2,500 mL (Fig 48).

Weekly Adequacy Values Meeting 2000 NKF-K/DOQIype (4 hr. D/P Cr Ratio), October 2002-March 2003.Project

Oct 2001-Mar 2002 Oct 2002-Mar 2003

igh-Avg/High Low/Low-Avg High-Avg/High Low/Low-Avg

73% 69% 74% 81%41 (�0.71) 2.40 (�0.69) 2.36 (�0.59) 2.37 (�0.48)

2.27 2.23 2.26 2.40

73% 80% 66% 79%.9 (�28.4) 77.5 (�32.3) 80.1 (�30.0) 72.9 (�26.6)

72.5 67.6 72.8 69.6

Low-Average � 0.50-0.64; High-Average � 0.65-0.81;

ly Kt/Vurea � 2.0 and a weekly creatinine clearance � 60k/1.73 m2 for low and low-average transporters.

) Weekly Adequacy Values Meeting 2000 NKF-K/DOQI2002-March 2003. 2003 ESRD CPM Project

Oct 2001-Mar 2002 Oct 2002-Mar 2003

ith DaytimeDwell

No DaytimeDwell

With DaytimeDwell

No DaytimeDwell

66% 61% 64% 58%33 (�0.55) 2.39 (�0.70) 2.31 (�0.54) 2.53 (�0.80)

2.25 2.29 2.25 2.38

55% 53% 49% 56%.0 (�26.3) 76.2 (�31.8) 66.5 (�22.2) 74.3 (�33.0)

65.7 68.1 62.3 70.2

): Kt/Vurea � 2.2; creatinine clearance � 66 L/wk/1.73 m2.2

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Fig 44. Distribution of Peritoneal Equilibration TestPET) results for adult peritoneal dialysis patients,ctober 2002-March 2003. 2003 ESRD CPM Project.

vOctober 2002-March 2003. 2003 ESRD CPM Project.

Fig 45. Distribution of single dwell volumes and 24-our total infused dialysate volumes for adult CAPD pa-

ients, October 2002-March 2003. 2003 ESRD CPM Project.

edProject.

Fig 46. Distribution of mean single nighttime dwellolumes for all adult cycler patients, October 2002-arch 2003. 2003 ESRD CPM Project.

Fig 47. Distribution of the mean number of night-ime exchanges for all adult cycler patients, October002-March 2003. 2003 ESRD CPM Project.

Fig 48. Distribution of mean single daytime dwellolumes for adult cycler patients with a daytime dwell,

Fig 49. Distribution of the mean number of daytimexchanges for adult cycler patients with a daytimewell, October 2002-March 2003. 2003 ESRD CPM

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9% of these patients had 1 daytime exchange,nother 37% had 2 daytime exchanges (Fig 49).

. CPM and Other Findings for October 2002-arch 2003 Compared to Previous Study Periods

The adequacy of peritoneal dialysis was re-orted for 88% of adult peritoneal dialysis pa-ients at least once during the 2003 6-monthtudy period, October 2002-March 2003 (PDdequacy CPM I), compared to only 82% during

he 1999 study period, 83% during the 2000tudy period, 85% during the 2001 study period,nd 86% during the 2002 study period (Fig 4).here has been an increase in the measurementf total solute clearance for urea and creatininealculated in a standard way reported by facilitytaff from 1999-2002 (PD Adequacy CPM II)Fig 4).

Although the percent of patients meeting NKF-/DOQI thresholds for peritoneal dialysis ad-

quacy3 has increased from the 1999 study pe-iod, there was little change in the percent ofatients meeting these thresholds from the 2001tudy period to the 2003 study period (Fig 50).

B. ANEMIA MANAGEMENT

. CPM Findings for October 2002-March 2003

Data to assess 3 anemia management CPMsere collected in 2003. The time period fromhich these data were abstracted was October002-March 2003.Anemia Management CPM I—The target

emoglobin is 11-12 g/dL (110-120 g/L). Pa-

Fig 50. Percent of adult peritoneal dialysis patientseeting 1997 NKF-DOQI guidelines for weekly Kt/Vurea

nd weekly creatinine clearance (PD Adequacy CPMII). 2003 ESRD CPM Project.

ients with a mean hemoglobin � 12 g/dL (120 n

/L) and not prescribed Epoetin were excludedrom analysis for this CPM.

FINDING: For the 6-month study period, 39%f the peritoneal dialysis patients who met thenclusion criteria (n � 1,227) had a mean hemo-lobin 11-12 g/dL (110-120 g/L).Anemia Management CPM IIa—For all ane-ic patients (hemoglobin � 11 g/dL [110 g/L])

r patients prescribed Epoetin, the percent trans-errin saturation and serum ferritin concentrationre assessed (measured) at least 2 times duringhe 6-month study period.

FINDING: 77% of the peritoneal dialysis pa-ients who met the inclusion criteria (n � 1,219)ad at least 2 documented (measured) transferrinaturation values and at least 2 documented (mea-ured) serum ferritin concentration values duringctober 2002-March 2003.Anemia Management CPM IIb—For all ane-ic patients (hemoglobin � 11 g/dL [110 g/L])

r patients prescribed Epoetin, at least 1 serumerritin concentration �100 ng/mL and at least 1ransferrin saturation �20% were documenteduring the 6-month study period.FINDING: 81% of the adult peritoneal dialy-

is patients who met the inclusion criterian � 1,219) had at least 1 documented transferrinaturation �20% and at least 1 documentederum ferritin concentration �100 ng/mL duringctober 2002-March 2003.Anemia Management CPM III—All anemic

atients (hemoglobin � 11 g/dL [110 g/L]) oratients prescribed Epoetin, with at least 1 trans-errin saturation �20% or at least 1 serum fer-itin concentration �100 ng/mL during the studyeriod are prescribed intravenous iron; UNLESShe mean transferrin saturation was �50% or theean serum ferritin concentration was �800

g/mL; UNLESS the patient was in the first 3onths of dialysis and was prescribed a trial

ose of oral iron.FINDING: 32% of the peritoneal dialysis pa-

ients who met the inclusion criteria (n � 524)ere prescribed intravenous iron at least onceuring the 6-month study period during October002-March 2003.

. Other Anemia Management Findings for October002-March 2003

The mean (�SD) hemoglobin for adult perito-
eal dialysis patients in the sample was 11.9

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�1.3) g/dL (119 [�13] g/L). The distribution ofean hemoglobin values for Black and White

atients is depicted in Fig 51. The mean hemoglo-in values and the proportion of patients withinifferent hemoglobin categories for gender, race,thnicity, age, diagnosis, duration of dialysis,ean serum albumin level, and weekly creati-

ine clearance are shown in Table 19. 79% ofatients had a mean hemoglobin �11 g/dL (110/L) (Fig 7). Significantly more Whites and pa-ients older than 55 years had a mean hemoglo-in �11 g/dL (110 g/L) compared to Blacks, andounger patients (Table 19). A larger percentagef patients with higher mean serum albumin andeekly creatinine clearance had a mean hemoglo-in �11 g/dL (110 g/L) compared to patientsith lower mean serum albumin and weekly

reatinine clearance values. Nationally, 66% ofatients prescribed Epoetin had a mean hemoglo-in 11-12.9 g/dL (110-129 g/L).The prevalence of patients with mean hemoglo-

in �10 g/dL (100 g/L) was 6% (Fig 51 andable 19). The prevalence of patients with meanemoglobin �10 g/dL (100 g/L) was signifi-antly higher in Blacks compared to Whites, foratients 18-54 years old compared to older pa-ients, patients dialyzing 2 or more years com-ared to patients dialyzing less than 2 years, andn patients with lower mean serum albumin and

Fig 51. Distribution of mean hemoglobin values fordult peritoneal dialysis patients in the United States,y race, October 2002-March 2003. 2003 ESRD CPMroject.

reatinine clearance values compared to patients o

ith higher mean serum albumin and creatininelearance values (Table 19).

The mean (�SD) transferrin saturation for theatients in this sample was 30.3% (�12.2%) and3% of patients had mean transferrin saturation20%. The mean (�SD) serum ferritin concen-

ration was 425 (�399) ng/mL, with 84% ofatients having a mean serum ferritin concentra-ion �100 ng/mL. 62 patients (5% of patients)ad both a mean transferrin saturation �20%nd a mean serum ferritin concentration �100g/mL.89% of the patients in the sample for analysis

ere prescribed Epoetin during the 6-month studyeriod. Epoetin was prescribed 99% of the timehen the mean hemoglobin values were �10/dL (100 g/L), 98% of the time when the meanemoglobin values were between 10-10.9 g/dL100-109 g/L), 97% of the time when meanemoglobin values were between 11-11.9 g/dL110-119 g/L), 89% of the time when meanemoglobin values were between 12-12.9 g/dL120-129 g/L), 70% of the time when meanemoglobin values were between 13-13.9 g/dL130-139 g/L), and 49% of the time when meanemoglobin values were 14 g/dL (140 g/L) orreater.Within the subset of patients who were pre-

cribed Epoetin, 99% were prescribed Epoetiny the SC route; 4% were prescribed Epoetin byhe IV route (groups not mutually exclusive).he mean (�SD) weekly Epoetin dose for pa-

ients prescribed Epoetin by the SC route was63.0 (�140.9) units/kg/wk; by the IV route was08.5 (�188.2) units/kg/wk.Iron use was assessed during this study period.

ron by either the oral or IV route was prescribedt least once during the 6 months for 61% of theatients in this sample, and 3 times over the-month period for 38% of the patients. Of theatients prescribed iron, 77% were prescribedral iron and 36% were prescribed IV iron (notutually exclusive categories). Among those pa-

ients with mean transferrin saturation �20%nd mean serum ferritin concentration �100g/mL (n � 62), 74% were prescribed either oralr IV iron at least once during the 6 months, and7% 3 times over the 6-month study period. 27%f these patients were prescribed IV iron at least
nce during the 6-month study period.

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. CPM and Other Findings for October 2002-arch 2003 Compared to Previous Study Periods

The percent of peritoneal dialysis patients withean hemoglobin �11 g/dL (110 g/L) increased

rom 55% to 79% from the 1998 to the 2003tudy periods (Fig 7). This improvement wasoted for both Black patients (from 38% to 73%)

Table 19. Mean Hemoglobin Values (g/dL) for AduOctober 2002-March 20

Patient CharacteristicMean Hemoglobin

(g/dL)

OTAL 11.9ENDERMen 12.0Women 11.8ACEAmerican Indian/Alaska Native 11.8Asian/Pacific Islander 12.1Black 11.6White 12.0Other/unknown 12.0

THNICITYHispanic 11.9Non-Hispanic 11.9

GE GROUP (y)18-44 11.845-54 11.755-64 12.165-74 12.075� 12.0AUSE OF ESRDDiabetes mellitus 11.9Hypertension 11.9Glomerulonephritis 11.8Other/unknown 12.0URATION OF DIALYSIS (y)�0.5 12.00.5-0.9 12.11.0-1.9 11.92.0-2.9 11.93.0-3.9 11.74.0� 11.8EAN SERUM ALBUMIN (g/dL)�3.5/3.2 (BCG/BCP)† 12.1�3.5/3.2 (BCG/BCP) 11.6EAN WEEKLY CREATININE

CLEARANCE (L/wk/1.73 m2)�60 12.0�60 11.7

NOTE. Percentages may not add up to 100% due to roung/L), multiply by 10. To convert serum albumin convention

*Value suppressed because n � 10.†BCG/BCP � bromcresol green/bromcresol purple labor

nd for White patients (63% to 81%). The mean

�SD) hemoglobin increased from 11.8 (�1.4 )/dL (118 [�14] g/L) during the 2002 studyeriod to 11.9 (�1.3) g/dL (119 [�13] g/L)uring the 2003 study period (Fig 8). The distri-ution of mean hemoglobin values over these 4tudy periods was not significantly different byodality (CAPD versus cycler).

oneal Dialysis Patients, by Patient Characteristics,03 ESRD CPM Project

Percent of Patients With Hemoglobin Values

10-10.9 11-11.9 12-12.9 13-13.9 14�

15 34 29 11 6

13 34 27 12 816 34 31 9 3

* * * * *16 33 27 * *17 33 27 9 413 34 30 11 6* 41 32 * *

11 35 30 11 *15 34 29 11 6

14 35 28 8 618 32 28 9 513 35 26 12 813 34 32 14 514 29 40 12 *

15 35 28 12 417 30 35 9 414 37 28 8 512 33 27 12 9

14 29 32 13 612 34 25 17 715 34 33 9 412 36 28 8 716 33 27 11 *18 35 27 8 5

12 31 33 13 719 37 24 8 3

14 34 31 11 617 36 27 9 4

o convert hemoglobin conventional units of g/dL to SI unitsof g/dL to SI units (g/L), multiply by 10.

ethods.

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eal dialysis patients with mean hemoglobin10 g/dL (100 g/L) decreased from 18% in the

998 study period to 6% in the 2003 study period

Table 20. Percent of Adult Peritoneal DialysisPatients With Mean Serum Albumin Values >4.0/3.7g/dL (BCG/BCP) and >3.5/3.2 g/dL (BCG/BCP) in theUnited States, by Patient Characteristics, October

2002-March 2003. 2003 ESRD CPM Project

Patient Characteristic

Percent of PatientsWith Mean Serum Albumin

�4.0/3.7 g/dL �3.5/3.2 g/dL

OTAL 18 60ENDERMen 21 62Women 15 57ACEAmerican Indian/

Alaska Native * *Asian/Pacific Islander 29 68Black 17 55White 17 60Other/unknown 27 73

THNICITYHispanic 19 66Non-Hispanic 18 59

GE GROUP (y)18-44 30 6945-54 21 5955-64 13 5865-74 10 5475� * 50

AUSE OF ESRDDiabetes mellitus 10 47Hypertension 20 68Glomerulonephritis 27 69Other/unknown 23 63URATION OF DIALYSIS (y)�0.5 12 510.5-0.9 21 601.0-1.9 20 652.0-2.9 20 603.0-3.9 17 624.0� 17 59EAN Hgb (g/dL)�11 21 64�11 7 45EAN WEEKLY CREATININE

CLEARANCE(L/wk/1.73 m2)

�60 17 61�60 22 61

NOTE. BCG/BCP � bromcresol green/bromcresolurple laboratory methods. To convert serum albuminonventional units of g/dL to SI units (g/L), multiply by 10.o convert hemoglobin conventional units of g/dL to SInits (g/L), multiply by 10.*Value suppressed because n � 10.

Fig 52. Percent of adult peritoneal dialysis patientsith mean hemoglobin <10 g/dL, by race, October002-March 2003 compared to previous study periods.003 ESRD CPM Project.

Fig 53. Mean weekly Epoetin dose (units/kg/wk) byemoglobin category for adult peritoneal dialysis patientsrescribed Epoetin, October 2002-March 2003 compared to

Fig 52).

Fig 54. Percent of adult peritoneal dialysis patientsith specific anemia management indicators, October002-March 2003 compared to selected previous study

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Figure 53 depicts the trend in Epoetin dosingrom the 1998 study period to the 2003 studyeriod, with an increasing mean weekly Epoetinose (units/kg/wk) for patients prescribed Epo-tin in lower hemoglobin categories. IV dosesere generally larger than SC doses (data notisplayed due to small cell sizes).The distribution of mean transferrin saturation

alues (%) and mean serum ferritin concentra-ions (ng/mL) was similar for the November996-April 1997 through the October 2002-arch 2003 study periods.Figure 54 depicts the status of iron stores for

he sampled patients for study period 2003 com-ared to selected previous study periods. Over-ll, 22% of patients were prescribed IV ironuring the 2003 study period compared to 10%uring the 1997 study period. 5% of patients hadmean transferrin saturation �20% and mean

erum ferritin concentration �100 ng/mL duringhe 2003 study period compared to 9% during the997 study period.

C. SERUM ALBUMIN

. Findings for October 2002-March 2003

The mean (�SD) serum albumin value foreritoneal dialysis patients whose value was de-ermined by the BCG method (n � 1,232) was.6 (�0.5) g/dL (36 [�5 ] g/L) and by the BCPethod (n � 117) was 3.2 (�0.5) g/dL (32 [�5]

/L). “Adequate” serum albumin was defined forhis report as �3.5/3.2 g/dL (35/32 g/L) (BCG/CP). “Optimal” serum albumin was defined as4.0/3.7 g/dL (40/37 g/L) (BCG/BCP). Nation-

lly, 18% of patients had a mean serum albumin4.0/3.7 g/dL (40/37 g/L) (BCG/BCP)). 60% of

atients had a mean serum albumin �3.5/3.2/dL (35/32 g/L) by the BCG/BCP methodTable 20).

The percent of patients with mean serum albu-in defined as either “adequate” or “optimal” by

ender, race, ethnicity, age, diagnosis, durationf dialysis, and selected clinical parameters ishown in Table 20. The percent of patients withoptimal” mean serum albumin tended to beigher for men compared to women, for patients8-44 years compared to older patients, for pa-ients with causes of their ESRD other thaniabetes mellitus compared to patients with dia-
etes mellitus as the cause and for patients with
ean hemoglobin �11 g/dL (110 g/L) comparedo patients with lower mean hemoglobin valuesTable 20).

. Findings for October 2002-March 2003ompared to Previous Study Periods

Figure 55 shows the percent of patients withean serum albumin �4.0/3.7 g/dL (40/37 g/L)

BCG/BCP) and the percent of patients withean serum albumin �3.5/3.2 g/dL (35/32 g/L)

BCG/BCP) during the 2003 study period com-ared to previous study periods.Although not consistent, there has been slight

mprovement in the proportion of adult perito-eal dialysis patients achieving either “ad-quate” or “optimal” mean serum albumin levelsrom the 1995 study period to the 2003 studyeriod.

V. PEDIATRIC IN-CENTER HEMODIALYSISPATIENTS

All patients aged �18 years identified as re-eiving in-center hemodialysis on December 31,002 were included in this study (n � 787). 663atients (84%) of this group met the case defini-ion and were included in the sample for analy-is. (See footnote to Table 5 for case definition.)

At this time, CPMs have not been developedor the pediatric age group. Therefore, the pediat-ic analysis is presented independently from thedult analysis.

Fig 55. Percent of adult peritoneal dialysis patientsith mean serum albumin >4.0/3.7 g/dL (BCG/BCP)*nd >3.5/3.2 g/dL (BCG/BCP), October 2002-March003 compared to previous study periods. 2003 ESRDPM Project.

This section describes the findings for pediat-

adult peritoneal dialysis patients

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