The Establishment Of Chinese National Renal Data System And The Analysis On The Incidence And Treatment For Anemia In Hemodialysis Patients

Background: Dialysis registration is an important component for standardizedmanagement of hemodialysis. Many developed countries have built comprehensiveregistration system, which in turn provide strong epidemic data support to guide theformulation of health insurance policy and the improvement of treatment. Theabsence of a national-level dialysis registration in China has limited the developmentof hemodialysis treatment, and it is now very important to establish a nation-widehemodialysis registration system.Anemia is a common complication for patients with maintenance hemodialysis(MHD), as well as an important factor affecting the prognosis of MHD patients.Despite treatment with high dose erythropoietin (EPO), the target value ofHemoglobin (Hb) can not be achieved in serval patgients. Therefore, we intend toleverage the national hemodialysis case registration system established earlier, tocollect the related Hb data for MHD patients, to analyze the incidence and currenttreatment of anemic MHD, and to support the formulation of Chinese treatmentguideline for anemic MHD.Objective:1. to establish the internet-based registration system for nationalhemodialysis cases.2. to study the utilization and registration status of the system.3.to study the current treatment pattern and influencing factors of anemic MHD inchina.Methods:1. the internet-based registration platform was first built using JavaEE,and the "Blood Purification Standard Operating Procedure (SOP)" was referred indesigning the registration file layout and contents.2. The data for2011was extractedto make the statistical analysis to the situation fo hemodialysis treatment in China.3.Data was exported for patients with erythropoietin (EPO) usage and Hb information from the registration system (data collection period ends at2011December31), withpatients aged18or older, duration of dialysis treatment shall be longer than6monthsand were survival in the end of2011. The above exported data shall be used toanalyze the incidence of anemic MHD in China, the utilization of EPO and ironagents, as well as factors influencing the incidence and treatment of anemia.Results:1. The national case registration system for hemodialysis is ainternet-based registration system. The content includes basic profile of the dialysiscenter, the device and employee information of the center, the device management ofdialysis water, patient profile, patient hemodialysis data, medical treatment data, labtest and supplementary results. Meanwhile, the system was also built withfunctions for data extraction, data query and statistics, as well as a discussion forumand publication platform for dialysis-related technologies.2. As of Dec31,2011,3,691dialysis centers (2.8centers per million population) have been registered inthe system, as well as165,936hemodialysis patients(124.8patients per millionpopulation).3. As of the end of2011,91,715of all the surviving dialysis patientshave registered the results of hemoglobin (Hb), with the average Hb level of91.1±23.1g/L, the percentage of patients with Hb≥110g/L is31.3%; the percentage of thepatients with TSAT≥20%is57.1%; the percentage of patients with SF≥200ng/mlis56.8%. The rate of patients using rHu EPO is82.6%, with a per week dosage of8890.2±6275.2U (median dosage is6000U), the rate of patients using intravenousiron is26.9%. Logistic regression analysis indicates dialysis membrane area is≥1.6m2, intravenous iron, levocarnitine, Alb≥40g/L, CRP≥10mg/dl and SF≥1000ng/dl etc are independent factors related to occurrence of MHD anemia.Conclusion:1. the establishment of the national case registration system forhemodialysis has ended the era in China where a national internet-based registrationsystem for dialysis has been absent. The design of the system not only meets theneeds for data registration, but also the needs for center management and businessinteraction.2. the system is still at the pilot stage where the completion rate and dataaccuracy are still low, and the improvement on data quality will be the key objective for the future research.3. The rate of meeting the protein standards among MHDpatients in China is low, despite the usage rate and dosage amount of erythropoietinis high, which means the treatment is less effective. Multivariate analysis indicatesthe main factors affecting the anemia rate of MHD patients in China include the areaof dialyzer, the usage of intravenous iron, the compliance rate of TSAT, the level ofserum albumin, C-reactive protein levels and ferritin level.