{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:56:04Z","timestamp":1789757764953,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Seminars in Dialysis"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anemia is a common occurrence in people with chronic kidney disease and end\u2010stage kidney disease. Intravenous administration of iron is standard treatment for people undergoing maintenance hemodialysis. However, until the recent PIVOTAL randomized control trial, there was uncertainty around clinically effective regimens. This study found that among incident, people receiving hemodialysis in the first year, a proactive high\u2010dose intravenous iron regimen was superior to reactive low\u2010dose regimen, leading to reduced mortality and cardiac events. Our study investigated whether the research and guidelines have been successfully implemented into clinical care across the United Kingdom, identified barriers experienced, and explored our local hemodialysis population's awareness of the treatment they are receiving.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross\u2010sectional survey using a convenient sample of UK\u2010based kidney physicians working in the NHS and local people receiving hemodialysis. Two preconceived, standardized questionnaires were designed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty physicians responded. Of these, 40% had implemented a proactive iron protocol, whereas 37.5% had not. Respondents acknowledged concerns about doses of iron and the need for local protocols. Thirty\u2010seven patients responded to the patient questionnaire within our own hemodialysis unit. Fifty\u2010one percent of patients reported to be receiving iron supplementation, of which 84% stated it was intravenous through their dialysis machine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have not observed a paradigm shift in clinical practice and identified poor patient understanding of their treatment. Strategies to overcome barriers are necessary to introduce treatments that offer both clinical advantages and cost savings. Eliminating futile practice is challenging due to departmental prioritization and economic considerations. Traditionally, efforts to improve care are targeted towards newer therapies; however, there is an opportunity to improve implementation of current evidence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/sdi.13250","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T05:44:08Z","timestamp":1741758248000},"page":"214-220","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["On the Cusp\u2014A Questionnaire\u2010Based Assessment of Implementing PIVOTAL Into UK Practice"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8569-773X","authenticated-orcid":false,"given":"Sebastian","family":"Spencer","sequence":"first","affiliation":[{"name":"University of Hull  Hull UK"},{"name":"Hull York Medical School  Hull UK"},{"name":"Hull University Teaching Hospitals NHS Trust  Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Hunter","sequence":"additional","affiliation":[{"name":"Hull University Teaching Hospitals NHS Trust  Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Hull York Medical School  Hull UK"},{"name":"Hull University Teaching Hospitals NHS Trust  Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2022.07.006"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2016-005473"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u20105908\u20107\u201050"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0084943"},{"key":"e_1_2_8_6_1","first-page":"279","article-title":"Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. 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Supplement"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102014\u2010003821"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1810742"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2019090972"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S304530"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10157\u2010017\u20101512\u20108"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X18801308"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/leader-2020-000296"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.109.934471"},{"key":"e_1_2_8_15_1","unstructured":"UK Renal Registry \u201cUK Renal Registry 24th Annual Report\u2014Data to 31\/12\/2020 Bristol UK \u201d (2022). Available fromhttps:\/\/ukkidney.org\/audit\u2010research\/annual\u2010report."},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467\u2010017\u20103688\u20102"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1159\/000321378"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs\u20102014\u2010003299"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/14.suppl_6.31"},{"key":"e_1_2_8_20_1","volume-title":"21st Century Patient Registries: Registries for Evaluating Patient Outcomes: A User's Guide","author":"Santanello N.","year":"2018"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010017\u20102314\u20100"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjcn\/zvad040"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.14874"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/crj.13112"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijn.13135"},{"key":"e_1_2_8_26_1","volume-title":"NICE Guideline [NG162]","author":"National Institute for Health and Care Excellence","year":"2019"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2017.05.002"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/1460458218796664"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kisu.2017.07.006"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(17)30788\u20102"}],"container-title":["Seminars in Dialysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/sdi.13250","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T08:26:10Z","timestamp":1747211170000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/sdi.13250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,6]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1111\/sdi.13250"],"URL":"https:\/\/doi.org\/10.1111\/sdi.13250","archive":["Portico"],"relation":{},"ISSN":["0894-0959","1525-139X"],"issn-type":[{"value":"0894-0959","type":"print"},{"value":"1525-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,6]]},"assertion":[{"value":"2024-01-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}