Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

摘要: Summary Background and objectives Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences predictors decision-making CKD. Design, setting, participants, & measurements A computerized survey administered between June August 2012 nephrologists, internists, hospitalists listed American Medical Association Masterfile. The quantified relative importance 10 patient attributes, including hemoglobin levels, age, occult stool, severity illness, eligibility transplant, iron indices, agents, cardiovascular disease, functional status. Triggers transfusions common dialysis scenarios were studied, based on conjoint-derived preferences, by performing multivariable regression assessed. Results total 350 providers completed ( n =305 nephrologists; mean age=46 years; 21% women). Of attributes assessed, absolute level most important driver transfusions, accounting 29% decision-making, followed status (16%) comorbidities (12%); 92% transfused when 7.5 g/dl, independent other factors. In regression, Veterans Administration more likely transfuse at 8.0 g/dl (odds ratio, 5.9; 95% confidence interval, 1.9 18.4). Although transplant explained only 5% nephrologists five times value it as compared with non-nephrologists 5.2; 2.4 to11.1). Conclusions Adaptive useful predicting influences decisions. Hemoglobin level, status, strongly influenced preference variations observed among subgroups.