Anemia Treatment and Its Clinical Implications in Patients Receiving Hemodialysis Hyporesponsive to Erythropoietin-Stimulating Agents.

RATIONALE &

OBJECTIVE

Anemia, highly prevalent among patients receiving maintenance dialysis, may be associated with adverse outcomes. This study describes the patient characteristics, anemia treatment patterns, clinical event rates, and health care resource utilization of patients receiving hemodialysis (HD) in the United States and in a subpopulation of patients hyporesponsive to erythropoietin-stimulating agents (ESAs).

STUDY

DESIGN

Using data from the US Renal Data System, a retrospective, population-based descriptive cohort study of adults with Medicare Parts A and B coverage receiving maintenance HD was conducted.

SETTING &

PARTICIPANTS

ESA hyporesponsiveness was defined as ESA Resistance Index ≥2 (ESA units/kg/wk/g hemoglobin/L) or ESA dose ≥450 U/kg/wk (within 8 weeks of index (January 1, 2018).

OUTCOMES: Anemia treatments and clinical events were assessed using medical claims during follow-up, until death, loss of Medicare, kidney transplantation, or December 31, 2019.

ANALYTICAL APPROACH: Outcome rates were calculated as number of events divided by follow-up time with 95% confidence intervals based on Poisson distribution.

RESULTS

Of the overall prevalent HD population (N = 209,408), 20,223 were ESA hyporesponders. Relative to the overall prevalent HD population, the ESA hyporesponder subpopulation had a higher rate of red blood cell transfusion events (91.1 [95% CI, 90.1-92.2] vs 32.4 [95% CI, 32.2-32.6] per 100 person-years [PY]), thromboembolic events (80.7 [95% CI, 79.3-82.2] vs 71.0 [95% CI, 70.6-71.4] per 100 PY), major adverse cardiovascular events (30.2 [95% CI, 29.6-30.9] vs 20.3 [95% CI, 20.2-20.5] per 100 PY), gastrointestinal erosions (61.8 [95% CI, 60.6-63.0] vs 40.2 [95% CI, 40.0-40.5] per 100 PY), and all-cause mortality (26.2 [95% CI, 25.6-26.8] vs 16.9 [95% CI, 16.8-17.1] per 100 PY). Hospitalizations occurred more frequently in the ESA hyporesponder subpopulation (2.45 vs 1.56 per PY) than in the overall prevalent HD population.

LIMITATIONS: This study was not designed to determine causality.

CONCLUSIONS

The ESA hyporesponder subpopulation had a high burden of red blood cell transfusion use, clinical events, and health care resource utilization.