Trends in the treatment of chronic kidney disease-associated anaemia in a cohort of haemodialysis patients: the Irish experience
Anaemia among haemodialysis patients is treated with iron and erythropoietin-stimulating agents (ESAs). ESAs reduce requirements for blood transfusions but are also expensive and overzealous use may be associated with adverse outcomes. Recent international trends have been characterised by reduced ESA doses and a greater reliance on intravenous (IV) iron. We determined trends in prescribing patterns of ESAs and IV iron for the treatment of anaemia in two representative Irish dialysis centres and correlated with current guidelines and international trends.
Patient data was accessed from the Kidney Disease Clinical Patient Management System (KDCPMS) for the period 2012 to 2014. We generated reports on ESA and iron doses, lab data (haemoglobin (Hb), transferrin saturation (TSAT) and ferritin) and patient population characteristics. We mapped the trends in ESA, iron dosing and lab parameters achieved. A linear mixed model determined the significance of these trends over time.
ESA dosing became lower in the second, third and fourth quarters of 2014. Dosing of iron increased throughout but a large increase was seen in the third and fourth quarters of 2014. Ferritin levels decreased and TSAT and haemoglobin levels increased. Changes in iron dosing were significant with p value of < 0.05.
Our findings are consistent with recent global trends toward increasing iron use. Such trends may have economic implications given the high cost of ESAs and the relative affordability of iron. In addition, the potential harm of excessive iron dosing may need to be considered.
KeywordsAnaemia Dialysis Erythropoetin Iron
This study was funded by the Health Research Board (grant number SS-2015-1431).
Compliance with ethical standards
Conflict of interest
Roisin Gardiner has received a research grant from the Health Research Board.
Donal Reddan is a consultant with Akebia and is on the data safety board of phase 3 anaemia studies.
Davood Roshan declares that he has no conflict of interest.
Denise Connolly declares that she has no conflict of interest.
Anne Brennan declares that she has no conflict of interest.
Susan Murray declares that she has no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
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