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Abstract: TH-PO968

Survey of Erythropoiesis-Stimulating Agent (ESA) Use in Non-Dialysis-Dependent CKD (NDD-CKD) in Civilian vs. Military Practice

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Oliver, James D., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Koehlmoos, Tracey L., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Background

There is a paucity of data on barriers to ESA use in the pre-dialysis chronic kidney disease (CKD) population. In the context of universal health care coverage within the Military Health System (MHS), we evaluated ESA use in patients with stage 3-5 NDD-CKD among nephrologists practicing in military facilities vs. former military nephrologists practicing in the civilian sector.

Methods

We conducted an anonymous online survey of nephrologists assigned to military facilities and graduates of the Walter Reed Nephrology fellowship program from 1988-2022 who have transitioned to civilian practice (n=104).

Results

The response rate was 63/104 (61%) with a 95% complete rate. Most of the respondents (97%) were in active clinical nephrology practice; 53% were in military facilities and 41% in civilian practice. Fifty-two percent of military and 29% of civilian nephrologists estimated that 5%-10% of their NDD-CKD patients were receiving ESA therapy (p=0.09). Sixty-eight percent of military nephrologists vs. 58% of civilian nephrologists would start an ESA if the hemoglobin (Hgb) ≤ 9 g/dL (p=0.46). Sixty-eight percent of military nephrologists vs. 62% civilian nephrologists targeted a Hgb between 10-11 g/dL on ESA (p=0.69). Patients had their ESA administered in the clinic, at home, or in both settings in 42%, 10%, and 45%, respectively, in military practice vs. 38%, 8% and 42%, respectively, in civilian practice (p=0.49). Compared to military nephrologists, civilian nephrologists were more likely to identify low reimbursement rate (29% vs. 0%, p=0.0013), drug cost and affordability (54% vs. 0%, p<0.001), and restriction on ESA formulations by health insurance (38% vs. 3%, p=0.001) as barriers to ESA therapy. Military nephrologists were more likely to report that there were no particular barriers to ESA therapy compared to their civilian counterparts (52% vs. 12%, p=0.002).

Conclusion

Although the practice patterns of ESA therapy in NDD-CKD are comparable between military and civilian nephrologists who had similar training/background, the former group experiences less barriers to implementing therapy in the MHS.

Disclaimer: The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy of the Department of Defense or the U.S. Government.

Funding

  • Other U.S. Government Support