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Abstract: TH-PO238

The Pursuit of a More Physiologic Iron and ESA Treatment: Results from a Triferic and Individualized ESA Protocol QA Project

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Chait, Yossi, University of Massachusetts, Amherst, Massachusetts, United States
  • Slater, Jonathan, Renal and Transplant Assoc of New England, Springfield, Massachusetts, United States
  • Nathanson, Brian Harris, OptiStatim, LLC, Longmeadow, Massachusetts, United States
  • Germain, Michael J., Renal and Transplant Assoc of New England, Springfield, Massachusetts, United States
Background

We implemented a new standard of care (SOC) anemia protocol using a web-based tool that individualizes Aranesp treatments and uses Triferic for iron supplementation. The objective was to observe changes in anemia parameters.

Methods

A QA project was conducted in a single hemodialysis (HD) clinic in 6/16-4/18: the standard bi-weekly Aranesp protocol and Venofer (phase A), Triferic replacing Venofer (phase B, 2 months “washout”+6 months), a new web-based weekly Aranesp dose titration tool and Triferic (phase C, 2 months “washout”+6 months). Target Hgb range was 9-11 g/dL with means 10 and 10.2 in phases A-B and C, respectively, and Tsat>30%. Monthly stats included patients who received at least one Aranesp dose during the recent 3-months period. We compared clinic-level monthly means for anemia related variables corresponding to standard SOC (6 months prior to phase B) and phases B and C using ANOVA with repeated measures and Cuzick’s nonparametric test for trend.

Results

A total of 105 patients were treated at the clinic during the 3 project phases. Monthly totals varied due to transfers, transplantation, and death (11, 10.5%). Demographics mean (SD) age 61.6 (15.4) years, 52 female (50%), 35 Latino (33%), 25 (24%) white, 20 (19%) black, 6 (6%) Asian, and 19 (18%) unknown. Anemia results for each phase are shown in Figure 1. Hgb means increased with the higher target mean; mean ferritin levels were significantly lower in phase C vs phase A or phase B (p<0.001); Tsat levels modestly decreased compared to phase A but remained on target; and mean Aranesp and mean total iron (Venofer and/or Triferic) were lower but statistically similar across protocols.

Conclusion

A more frequent dosing schedule, which integrates Triferic for iron management with a web-based tool for individualized Aranesp treatments, performed better than a standard anemia protocol in HD patients. Patients were more likely to have Hgb in the target range or higher, lower but not significantly different dosages of Aranesp and total iron, reduced Ferritin levels and maintain Tsat levels on target.

Funding

  • Commercial Support