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Kidney Week

Abstract: TH-PO985

Anemia Treatment Among Prevalent Hemodialysis and Peritoneal Dialysis Patients in the United States

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Liu, Jiannong, Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Rouette, Julie, GSK, Montreal, Quebec, Canada
  • Li, Suying, Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Wetten, Sally, GSK, Brentford, Middlesex, United Kingdom
  • Guo, Haifeng, Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Requena, Gema, GSK, Brentford, Middlesex, United Kingdom
  • Mu, George, GSK, Collegeville, Pennsylvania, United States
  • Ma, Liyuan, GSK, Collegeville, Pennsylvania, United States
  • Fairburn-Beech, Jolyon, GSK, Brentford, Middlesex, United Kingdom
  • Gilbertson, David T., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Richards, Anna, GSK, Brentford, Middlesex, United Kingdom
  • Wetmore, James B., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

This study aims to assess anemia treatment in chronic kidney disease (CKD) patients (pts) undergoing dialysis to understand the evolving landscape of CKD anemia management.

Methods

Using USRDS data, we conducted an observational, descriptive cohort study of adults (≥18 years) receiving dialysis on Jan 1, 2018 (index) and with 6 months of Medicare fee-for-service coverage pre-index. Pts with prior kidney transplant, cancer, and hospitalization for heart failure, myocardial infarction, or stroke in the previous month were excluded. Follow-up was from index until death, loss of Medicare coverage, kidney transplantation, or Dec 31, 2019. Use of erythropoiesis-stimulating agents (ESA), IV iron, and blood transfusions were assessed during follow-up. ESA, iron use, and transfusions were identified by a combination of HCPCS codes, ICD-10-PCS procedure codes, and/or revenue center codes. ESA use was calculated as days covered/week (total days covered by ESA divided by follow-up time in weeks; 3 epoetin alfa administrations covered 7 days; 1 darbepoetin for 14 days), IV iron calculated as number of administrations per week, and transfusions as number per 100 person-years. Overall rates were calculated as weighted mean of pt-level rates using follow-up as weight.

Results

Overall, 209,408 pts were on HD and 20,647 on PD; median follow-up was 24.0 months (HD, IQR: 14.6–24.0; PD, 13.0–24.0), PD pts were younger (median age 62.2 vs 64.7 yrs). More PD pts were White (53.5 vs 39.1%), higher income (34.0 vs 48.7% with Medicare/Medicaid dual enrollment), and with glomerulonephritis as the cause of end-stage kidney disease (15.2 vs 8.5%). PD pts had fewer comorbidities and shorter dialysis duration (median 2.7 vs 3.9 yrs). During follow-up (Table), PD pts had lower ESA and IV iron use (1.24 vs 2.64 days of ESA coverage/week; 0.15 vs 0.48 iron administrations/week) and a higher transfusion rate (38.3 vs 32.4 /100 person-years).

Conclusion

In this descriptive study, PD pts had lower ESA and iron use and a higher transfusion rate than HD pts during follow-up. Anemia management may need improvement among PD patients.

Funding

  • Commercial Support – Funded by GSK (Study 217316)