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The Scientific World Journal
Volume 2013, Article ID 260915, 8 pages
http://dx.doi.org/10.1155/2013/260915
Research Article

Renal Anemia Control in Lithuania: Influence of Local Conditions and Local Guidelines

1Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Mickeviciaus str. 9, LT-44307 Kaunas, Lithuania
2Nephrological Clinic, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu str. 2, LT-50009 Kaunas, Lithuania

Received 15 September 2013; Accepted 28 October 2013

Academic Editors: F. Hinoshita and R. Sakai

Copyright © 2013 Edita Ziginskiene et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Erythropoietin stimulating agents had a long haul in Lithuania—we had no epoetin till 1994 and there was no intravenous iron in 2001–2004. The aim of this study was to assess the changes of renal anemia control in hemodialysis patients from early independence of Lithuania till nowadays and to evaluate the link of anemia with hospitalization rates and survival and hemoglobin variability in association with mortality. In December of each year since 1996 all hemodialysis centers have been visited and data has been collected using special questionnaires. The history of renal anemia control in Lithuania was complicated; however, a significant improvement was achieved: 54.7% of hemodialysis patients reached the target hemoglobin; all patients have a possibility of treatment with epoetin and intravenous iron. The involuntary experiment with an intravenous iron occurred in Lithuania because of economic reasons and confirmed the significant role of intravenous iron in the management of renal anemia. Hemoglobin below 100 g/L was associated with a 2.5-fold increase in relative risk of death and 1.7-fold increase in relative risk of hospitalization in Lithuanian hemodialysis patients. Although hemoglobin variability was common in Lithuanian hemodialysis patients, we did not find the association between hemoglobin variability and all-cause mortality in our study.