Epoetin alfa use in patients with ESRD: an analysis of recent US prescribing patterns and hemoglobin outcomes.
BACKGROUND
It is unknown to what degree physicians adjust erythropoietin doses to achieve hemoglobin levels (11.0 to 12.0 g/dL [110 to 120 g/L]) recommended by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) for patients with end-stage renal disease receiving hemodialysis. Our objective is to examine epoetin alfa prescribing patterns for achieving the target hemoglobin level range in this population.


METHODS
Monthly hemoglobin levels and epoetin alfa doses from 2 large databases were retrospectively analyzed. One data set comprised 31,267 patients from the Fresenius Medical Care-North America (FMC-NA) database, and the other comprised 128,761 patients based on claims for Medicare services.


RESULTS
Longitudinal evaluation of the FMC-NA data set showed that hemoglobin levels in patients administered epoetin alfa cycled in and out of the NKF-K/DOQI hemoglobin target range, and doses were decreased in 98.8% of patients with persistent hemoglobin levels greater than 12.0 g/dL (> 120 g/L). Hemoglobin levels in patients from the Medicare data set that initially were outside the target range migrated into the range with epoetin alfa dose titration. FMC-NA patients with a 3-month average hemoglobin level less than 11.0 g/dL (< 110 g/L) were administered significantly greater epoetin alfa doses than those with average hemoglobin levels greater than 12.0 g/dL (> 120 g/L; 21,838 versus 13,503 U/wk; P < 0.0001). Less than 0.4% of patients administered epoetin alfa were persistently anemic (hemoglobin < 11.0 g/dL [< 110 g/L]) and were administered persistently high doses (> 30,000 U/wk), but failed to respond with a 0.5-g/dL or greater (> or = 5-g/L) increase in hemoglobin levels.


CONCLUSIONS
In these analyses, few hemodialysis patients experienced persistent anemia while being administered high epoetin alfa doses. Physicians appeared to appropriately adjust doses to achieve hemoglobin levels recommended by the NKF-K/DOQI guidelines.
Collins
Allan J
AJ
Chronic Disease Research Group, Minneapolis Medical Research Foundation, University of Minnesota, Minneapolis, MN, USA.
Brenner
Robert M
RM
Ofman
Joshua J
JJ
Chi
Eric M
EM
Stuccio-White
Nina
N
Krishnan
Mahesh
M
Solid
Craig
C
Ofsthun
Norma J
NJ
Lazarus
J Michael
JM
D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D019983:Guideline Adherence; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011994:Recombinant Proteins; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa