Survival benefit of recombinant human erythropoietin administration prior to onset of end-stage renal disease: variations across surrogates for quality of care and time.
BACKGROUND
Recombinant human erythropoietin (rHuEPO) is recommended pre-dialysis to correct the anemia of chronic kidney disease. This study evaluated the impact of pre-dialysis rHuEPO on mortality in incident end-stage renal disease (ESRD) patients with varying levels of pre-ESRD care.


METHODS
The study included 15,807 individuals whose exposure to rHuEPO was determined from HCFA 2728 forms.


RESULTS
Median follow-up after starting dialysis was 32.8 months. Pre-ESRD rHuEPO use occurred in only 3,994 (25.3%) subjects and was more common in individuals with insurance, currently employed, started on outpatient dialysis, and initiated on peritoneal dialysis. During the study, 8,608 (54.5%) patients died. The risk of death was lower for rHuEPO-treated patients versus non-treated (relative risk 0.87, 95% CI 0.82-0.92). The survival benefit with rHuEPO was greatest early after dialysis initiation (relative risk at 1 vs. 7 years post-dialysis 0.73, 95% CI 0.66-0.80 vs. 0.87, 95% CI 0.82-0.92, respectively), did not vary across several surrogates for quality of care, and was greatest in those with the highest achieved hematocrit pre-ESRD.


CONCLUSIONS
Pre-dialysis rHuEPO confers a survival benefit that depends on achieved hematocrit and diminishes post-dialysis, but is independent of several surrogates for quality of care except for insurance status pre-ESRD.
Lu
Wei X
WX
The Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Md 21201-1595, USA.
Jones-Burton
Charlotte
C
Zhan
Min
M
Salzberg
Daniel J
DJ
Moore
Jack
J
Fink
Jeffrey C
JC
D000368:Aged; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D011994:Recombinant Proteins; D012189:Retrospective Studies; D015996:Survival Rate
D011994:Recombinant Proteins; D004921:Erythropoietin