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J Ebben

Publications and source records attributed to J Ebben.

12 recordsLinked to original sources
PubMed2000

Hematocrit levels and associated Medicare expenditures.

Clinical studies and the National Kidney Foundation-Dialysis Outcomes Quality Initiative guidelines suggest that a target hematocrit of 33% to less than 36% is appropriate for patient benefit. Previous studies have shown an association of lower risks for death and hospitalization when hematocrits were 33% to less than 36%. In this study, we assessed the relationship between hematocrit value and associated Medicare expenditures, analyzing incident Medicare hemodialysis patients from January 1, 1991, through June 30, 1995. All patients survived at least 90 days to normalize eligibility and an additional 6-month entry period to assess comorbidity and hematocrit values. All patients were followed up from July 1, 1991, through December 31, 1996. We assessed the association between hematocrit values in the 6-month entry period and the Medicare-allowable Part A and Part B per-member-per-month (PMPM) expenditures in the follow-up period, controlling for other variables, including patient demographic characteristics, comorbid conditions, and severity of disease. We found that hematocrits of 33% to less than 36% and 36% and higher were associated with lower Medicare-allowable payments in the follow-up period. Compared with reference patients with hematocrits of 30% to less than 33%, the Medicare-allowable PMPM expenditures were significantly greater for patients with hematocrits less than 27% and 27% to less than 30% (12. 7% and 5.3%, respectively), and the Medicare-allowable PMPMs were significantly less for patients with hematocrits of 33% to less than 36% and 36% and higher (6.0% and 8.2%, respectively). Although these findings suggest that the treatment of anemia may be associated with significant savings in total patient Medicare expenditures, caution should be considered because these findings are associations and should not be deemed as showing causality.

Adult↗
PubMed2000

Impact of hematocrit on morbidity and mortality.

It has been 10 years since epoetin-alpha was approved by the federal Food and Drug Administration for use in end-stage renal disease patients. Over this period of time, clinical studies have shown a relationship between the correction of anemia and improved cardiac function, cognitive ability, sexual function, and exercise capacity. Recent large epidemiological studies have shown that mortality and morbidity are reduced when the hematocrit (Hct) level is in the range 33% to 36%, and the National Kidney Foundation's Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines recommend a target Hct of 33% to 36% to enhance patient outcomes. The most recent mortality studies show that Hcts less than 30% (or hemoglobins less than 110 gm/L) are associated with an 18% to 40% increased associated risk of death and hospitalizations. Higher Hcts in the 33% to 36% range appear to be associated with a 7% reduced risk of death and hospitalizations compared with patients with Hcts of 30% to less than 33%. Patients with sustained Hcts of 33% to 36% over 1 year appear to have the best outcome compared with patients with Hcts that fall. These studies suggest that the factors that may influence patients' ability to move into higher Hct ranges need to be determined to enhance patient outcomes. Dramatic improvement in hemodialysis patient Hct levels has occurred since 1989. Mortality and hospitalization studies support the NKF-DOQI target Hct range of 33% to 36% as providing the best associated outcomes.

Anemia, Iron-Deficiency↗
PubMed1999

Hematocrit level and associated mortality in hemodialysis patients.

Although a number of clinical studies have shown that increased hematocrits are associated with improved outcomes in terms of cognitive function, reduced left ventricular hypertrophy, increased exercise tolerance, and improved quality of life, the optimal hematocrit level associated with survival has yet to be determined. The association between hematocrit levels and patient mortality was retrospectively studied in a prevalent Medicare hemodialysis cohort on a national scale. All patients survived a 6-mo entry period during which their hematocrit levels were assessed, from July 1 through December 31, 1993, with follow-up from January 1 through December 31, 1994. Patient comorbid conditions relative to clinical events and severity of disease were determined from Medicare claims data and correlated with the entry period hematocrit level. After adjusting for medical diseases, our results showed that patients with hematocrit levels less than 30% had significantly higher risk of all-cause (12 to 33%) and cause-specific death, compared to patients with hematocrits in the 30% to less than 33% range. Without severity of disease adjustment, patients with hematocrit levels of 33% to less than 36% appear to have the lowest risk for all-cause and cardiac mortality. After adjusting for severity of disease, the impact of hematocrit levels of 33% to less than 36% is vulnerable to the patient sample size but also demonstrates a further 4% reduced risk of death. Overall, these findings suggest that sustained increases in hematocrit levels are associated with improved patient survival.

Adult↗
PubMed1999

Hematocrit levels and hospitalization risks in hemodialysis patients.

The association between hematocrit level and future hospitalization risks in hemodialysis patients has not been fully investigated on a national level. A total of 71,717 prevalent Medicare hemodialysis patients who survived a 6-mo entry period from July 1 through December 31, 1993 were studied, and their risk of hospitalizations was evaluated the next year. Five hematocrit groups were defined from Medicare recombinant human erythropoietin-treated patients: <27%, 27 to <30%, 30 to <33%, 33 to <36%, and > or =36%. A Cox regression model was used to investigate the association between hematocrit level and the risk of first hospitalization, and the Andersen-Gill regression model evaluated multiple hospitalizations during the next year, adjusting for patient comorbidity and severity of disease. Compared with the baseline group of 30 to <33%, patients with hematocrit levels <30% had a 14 to 30% increased risk of hospitalization without disease severity adjustment (p = 0.0001) and a 7 to 18% increased risk with disease severity adjustment (p = 0.0001). Patients in the 33 to <36% group had the lowest risk at 0.93 and 0.88 (p = 0.0001), with and without adjustment for disease severity. It is concluded that patients with hematocrits of <30% have an increased risk of future hospitalization, with hematocrit levels between 33 and 36% having the lowest associated risks.

Adult↗
PubMed1998

Trends in anemia treatment with erythropoietin usage and patient outcomes.

Recombinant erythropoietin, first approved for Medicare reimbursement in June 1989, was prescribed at initial doses for dialysis patients of 2,500 to 2,700 U per administration independent of hematocrit level. By 1997, however, patients with hematocrits less than 30% were administered 6,000 U/dose, compared with 4,500 U administered to patients with hematocrits of 33% to 36%. Since 1990, the percentage of patients with hematocrits less than 30% decreased from 60% to 22% in 1997, whereas the percentage of patients with hematocrits of 33% to 36% increased from 10% to 30%. In 1997, Medicare initiated the Hematocrit Measurement Audit (HMA) policy, which was directed at reducing the percentage of claims for hematocrits greater than 36% and increasing the stability of the hematocrit levels. The policy change achieved the initial effect but resulted in a reduction of the mean hematocrit as well. The policy was changed in 1998 in response to patient and provider concerns. Mortality studies show that hematocrits less than 30% (or hemoglobin levels < 110 g/L) are associated with an 18% to 40% increased associated risk for death. Higher hematocrits of 33% to 36% appear to be associated with a 7% reduced risk for death. The risk for hospitalization parallels that of mortality. Patients with sustained hematocrits of 33% to 36% over 1 year appear to have the best outcome compared with patients with hematocrits that decrease. The latter are at greater risk than those patients in whom the hematocrits increase. In conclusion, dramatic improvements in hemodialysis patient hematocrits have occurred since 1989. Mortality and hospitalization studies support the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF DOQI) target hematocrit range of 33% to 36% as providing the best associated outcomes.

Anemia↗
PubMed1981

Three hollow fiber dialyzers.

Hollow fiber dialyzers with a variety of sizes and performance characteristics are presently available for the dialysis of adult patients. We evaluated three currently available follow fiber adult dialyzers in vitro and in vivo during treatment of adult patients. All three dialyzers, Gambro GF-120H, Gambro GF-120L, and Travenol CF-1211 were well suited for the dialysis of adult patients. By considering the clinical status of the patients and the performance characteristics of the dialyzer (solute removal, ultrafiltration, priming volume, etc.), it is possible to employ the follow fiber dialyzer which most precisely meets the needs of the patient, without increasing risk factors associated with hemodialysis.

Adult↗
PubMed1981

Time of death, recovery of renal function, development of chronic renal failure and need for chronic hemodialysis in patients with acute tubular necrosis.

We analyzed 432 patients with acute tubular necrosis, dialyzed at the University of Minnesota Dialysis Unit between 1968-1979. Only 135 patients or 31% survived. The median time to death was 5 days and to recovery of renal function was 12 days. Serum creatinine continued to fall for one month after the last dialysis and then stabilized. Ultimate serum creatinine level was directly related to age of patient but not duration of need for dialysis. One-fourth of the patients were left with moderate renal insufficiency (creatinine 1.5-3 mg/dl). Eight of 82 (10%) of the patients with long term (greater than 1 mo follow-up) had severe renal failure (creatinine over 3 mg/dl) and 4 other patients never recovered renal function but needed chronic hemodialysis. Acute renal failure is numerically important but not very time demanding on the capacity of dialysis units. The majority of the patients have no clinical problem of renal dysfunction if they survive their basic disease leading to acute tubular necrosis.

Acute Kidney Injury↗
PubMed1980

Four new dialyzers.

Dialyzers with a variety of sizes and performance characteristics are presently available for the dialysis of adult patients. We evaluated four currently available disposable adult dialyzers in vitro and in vivo during treatment of adult patients. All four dialyzers, Gambro GLP 1.36m2, 17 mu, Cordis Dow 3500, Gambro GF 120M, and Travenol HD 1000 were well suited to the dialysis of adult patients. By considering the clinical status of the patients and the performance characteristics of the dialyzer (solute removal, priming volume, ultrafiltration, etc.) it is possible to employ a hemodialyzer which more precisely meets the needs of the patient without increasing risk factors associated with hemodialysis.

Arteries↗
PubMed1978

Evaluation of three dry-sterilized hollow fiber artifical kidneys.

We investigated three new dry sterilized hollow fiber artificial kidneys (HFAK) (Cordis Dow CDAK 1.3, Travenol CF 1200, Extracorporeal Tri-Ex 1). Dry sterilization makes these dialyzers more economical by shortening set-up time. Dry sterilization also eliminates iatrogenic administration of residual sterilant. Water of imbibition can significantly increase the blood compartment volume of the dialyzer during dialysis. Consequently, a corrected blood volume for each dialyzer was established; these corrected volumes varied from 13--36% greater than the volume determined before dialysate flow. With low dose heparinization of these dialyzers there was between an 18 and 45% decrease in the post dialysis volume, presumably due to fiber clotting during dialysis. This volume added to the residual blood loss measured by a colorimetric technique accounted for a possible blood loss ranging between 26.9 and 53.9 ml per dialysis for these three dialyzers. Our results suggest that a relationship between dialyzer clotting and decreased dialyzer efficiency may exist. These three capillary flow dialyzers had a much lower platelet drop (0--9% pre to post) when compared to 30--40% drop of flat plate dialyzers. These dialyzers were found to be safe and easy to use but the high fiber clotting warrants further investigation in chronic dialysis patients on high dose heparin.

Kidneys, Artificial↗