A study of the response of elderly patients with end-stage renal disease to epoetin alfa or beta.
BACKGROUND
Anaemia correction in patients with end-stage renal disease has been enhanced following the use of epoetin alfa or beta and there are a number of studies detailing its application. Dialysis centres are dealing with greater numbers of elderly patients and anaemia correction in these individuals may differ by virtue of co-existing comorbidity and their age.


OBJECTIVE
The aim of this study was to examine the response of the elderly patients to anaemia correction using a locally devised anaemia correction protocol while receiving dialysis.


METHODS
An incident, non-randomised, cohort observational study in a single centre was used to compare the correction of anaemia in a population of elderly (> or =65 years of age) and young dialysis patients. All incident patients starting peritoneal dialysis and haemodialysis (HD) between January 1998 and December 2000 were selected and treated using a locally devised anaemia correction protocol and observed for at least 1 year. Anaemia correction following adjustments for factors such as age, comorbidity, dialysis type, dialysis access type and predialysis nephrological care was assessed.


RESULTS
198 patients commenced dialysis with 86 elderly patients (mean age +/- SD 73.7 +/- 4.9 years). The elderly patients had similar periods of predialysis nephrological care as the younger patients. Most patients received HD and required a tunnelled dialysis catheter (TC) as vascular access. Equivalent numbers of elderly patients received peritoneal dialysis. Comorbid scores were greater in the elderly and patient survival was dependent upon these comorbid factors. Following the strict use of TCs, patient survival was similar to those patients commencing HD with arterio-venous fistulae. Anaemia correction in the elderly was similar to the younger patients, with a median haemoglobin of 11.3 g/dL. By 6 months of dialysis, most patients achieved the UK Renal Association anaemia correction standard (haemoglobin above 10 g/dL). The elderly patients maintained significantly higher serum ferritin levels throughout (median 209 microg/L) and required less epoetin alfa or beta (median 91.6 units/kg/wk), indicating that functional iron deficiency in the elderly dialysis patients is less. Intravenous iron sucrose doses were similar in both age groups and iron overload (serum ferritin above 800 microg/L) had been avoided following the use of the intravenous iron protocol.


CONCLUSIONS
The study has noted that elderly patients responded to anaemia corrective therapies as well as the younger patients, despite greater levels of comorbidity while requiring less epoetin alfa or beta.
Nicholas
Johann C B
JC
Renal Dialysis Unit, New Cross Hospital, Wolverhampton, UK. Dr.Nicholas@rwh-tr.nhs.uk
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000740:Anemia / Q000150:complications / Q000188:drug therapy*; D015897:Comorbidity; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005293:Ferritins / Q000097:blood; D005853:Geriatrics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011994:Recombinant Proteins; D006435:Renal Dialysis; D016019:Survival Analysis; D016896:Treatment Outcome
D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin; D000068817:Epoetin Alfa; D005293:Ferritins