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Abstract: PO0471

Contemporary Anemia Treatment in Prevalent Patients Undergoing Hemodialysis

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

Anemia treatment remains a major area of focus in the management of maintenance dialysis patients. We assessed hemoglobin (Hb) and erythropoiesis-stimulating agent (ESA) dosing among hemodialysis (HD) patients with records in CROWNWeb, a national reporting system that captures data from all prevalent patients undergoing maintenance dialysis, regardless of whether patients carry Medicare coverage.

Methods

We analyzed United States Renal Data System Standard Analysis Files. For each calendar month from January 2015 to September 2019, we identified adult (age ≥18 years) patients who underwent HD during the entire month and whose CROWNWeb records included a valid measurement of single-pool Kt/V. In each patient-month, we identified Hb and ESA treatment (agent [epoetin alfa, darbepoetin alfa, or pegylated epoetin beta] and monthly cumulative dose). Subsequently, we tabulated the distribution of Hb in each month, incidence of 3-month and 6-month series with Hb <10.0 g/dL; utilization of ESAs, overall and by agent; and mean weekly ESA dose, by agent.

Results

Among 878,883 patients in the study period, 7.2% of patient-months had Hb <9.0 g/dL, 15.2% had Hb 9.0-9.9 g/dL, 35.3% had Hb 10.0-10.9 g/dL, 28.5% had Hb 11.0-11.9 g/dL, and 13.9% had Hb ≥12.0 g/dL. The prevalence of Hb <9.0 g/dL was relatively higher with age 18-44 years, Black race, and female sex. Among all 6-month series of Hb measurements, 5.8% had Hb <10.0 g/dL for 3 consecutive months and only 2.0% had Hb <10.0 g/dL for 6 consecutive months. Approximately 76% of patients received an ESA in each month. In 2019, 34% used epoetin alfa, 9% used darbepoetin alfa, and 33% used pegylated epoetin beta. Mean (median) weekly doses were 10,562 (7727) IU for epoetin alfa, 35.9 (23.0) mcg for darbepoetin alfa, and 33.6 (23.0) mcg for pegylated epoetin beta.

Conclusion

Between 2015 and 2019, despite substantial flux in the mix of ESAs used, distributions of hemoglobin and ESA doses among patients undergoing HD were stable, with only a small percentage of patients experiencing persistently low hemoglobin.

Funding

  • Commercial Support