Anemia treatment in the pre-ESRD period and associated mortality in elderly patients.
BACKGROUND
Anemia is a common complication of advancing chronic kidney disease, yet little is known about the consistency of anemia treatment before end-stage renal disease (ESRD) and mortality on dialysis therapy.


METHODS
We studied 89,193 incident Medicare patients with ESRD in 1995 to 1997 aged 67 plus years with claims 2 years before their dialysis therapy initiation. Patients were classified as follows: no epoetin, 25% or less (least consistent), greater than 25% to 50%, greater than 50% to 75%, and greater than 75% (most consistent) epoetin treatment in the available months from the first pre-ESRD epoetin dose to the first ESRD service date. Cox regression modeled the risk for 1-year death in the post-ESRD period, adjusting for age, sex, race, diabetic status, albumin level, and incidence year.


RESULTS
Sixty percent of patients had hematocrits less than 30% at ESRD initiation, yet only 15.6% (N = 13,877) had epoetin claims before ESRD. The most consistent epoetin treatment group had hematocrits increase from 27.5% to 30.8% (P < 0.0001) by month 4 of treatment. Patients with the most consistent epoetin treatment had a greater mean hematocrit (29.2% +/- 0.11%; P < 0.0001) and albumin level (3.31 +/- 0.01 g/dL [33.1 g/L]) at initiation than those with the least consistent treatment (28.1% +/- 0.10% and 3.21 +/- 0.01 g/dL [32.1 g/L], respectively). The relative risk for death in patients with the least consistent versus the most consistent (the reference) epoetin treatment was 1.460 (95% CI, 1.245 to 1.713; P < 0.0001) 1 year after the first ESRD service date.


CONCLUSIONS
Elderly patients with consistent pre-ESRD epoetin treatment had lower risks for death in the first year of dialysis therapy after ESRD initiation.
Xue
Jay L
JL
Nephrology Analytical Services, Minneapolis, MN, USA.
St  Peter
Wendy L
WL
Ebben
James P
JP
Everson
Susan E
SE
Collins
Allan J
AJ
D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood; D004334:Drug Administration Schedule; D000068817:Epoetin Alfa; D004909:Erythrocyte Indices / Q000187:drug effects; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006400:Hematocrit; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality*; D008297:Male; D015233:Models, Statistical; D009026:Mortality / Q000639:trends; D044469:Racial Groups; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000401:mortality; D015203:Reproducibility of Results; D012709:Serum Albumin / Q000187:drug effects; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends
D011994:Recombinant Proteins; D012709:Serum Albumin; D004921:Erythropoietin; D000068817:Epoetin Alfa