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Kidney Week

Abstract: PO0470

Anemia Treatment Patterns and First-Year Cardiovascular Outcomes in Incident ESKD Patients Undergoing Hemodialysis (2015-2018)

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Weinhandl, Eric D., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Eggert, William, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Petersen, Jeffrey, Amgen Inc, Thousand Oaks, California, United States
  • Hwang, Yunji, Amgen Inc, Thousand Oaks, California, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

The first months of maintenance hemodialysis are characterized by a relatively high rate of death and by correction of anemia—mean hemoglobin (Hb) among incident end stage kidney disease (ESKD) patients is only 9.3 g/dL (source: 2020 USRDS Annual Data Report)—so it is hypothesized that new anti-anemia treatments could be utilized to improve outcomes. We assessed Hb, erythropoiesis-stimulating agent (ESA) dosing, and major adverse cardiac event-plus (MACE+) incidence during the first year of hemodialysis (HD), among users of either epoetin alfa (EPO) or darbepoetin alfa (DARB).

Methods

We analyzed United States Renal Data System Standard Analysis Files. The cohort comprised patients with newly diagnosed ESKD between 1 Jan 2015 and 30 Sep 2018 and whose primary modality was HD. We retained patients who used either EPO or DARB during the first month of HD, per CROWNWeb data. We followed patients until the earliest of kidney transplant, death, the end of the first year of ESKD, or 30 Sep 2019. During follow-up, we tabulated mean Hb and weekly ESA dose, by month. Among patients with Medicare coverage, we estimated the incidence of MACE+, as defined by death, myocardial infarction, stroke, or hospitalization for heart failure.

Results

Among 251,342 incident ESKD patients who initiated both HD and ESA treatment, 130,736 and 50,197 used EPO and DARB, respectively. Among EPO users, mean Hb was 9.9 g/dL in month 1 and between 10.6 and 10.7 g/dL thereafter. Mean weekly doses of EPO were 13,064 IU in month 1; 10,922 IU in month 4; 10,212 IU in month 7; and 9756 IU in month 10. Among DARB users, mean Hb was between 9.9 g/dL in month 1 and between 10.4 and 10.6 g/dL thereafter. Mean weekly doses of DARB were 39.3 mcg in month 1; 33.5 mcg in month 4; 32.5 mcg in month 7; and 31.7 mcg in month 10. Among EPO and DARB users, the cumulative incidence of MACE+ was 28.7% at 6 months and 49.1% at 12 months.

Conclusion

Anemia treatment among incident HD patients using either EPO or DARB is characterized by a brief increase in Hb, reaching a plateau of 10.5 to 10.7 g/dL, and steadily declining ESA doses during the first year. The incidence rate of MACE+ remains higher during the early versus late part of the first year. Real-world data are useful when evaluating benefits and risks of new anti-anemia treatments.

Funding

  • Commercial Support