title: Postdialysis outcomes associated with consistent anemia treatment in predialysis patients with chronic kidney disease.
abstract: OBJECTIVE
  Anemia and cardiovascular (CV) events are major complications of chronic kidney disease (CKD) during dialysis. We conducted a retrospective observational study in CKD patients with anemia to evaluate the association between predialysis use of erythropoiesis-stimulating agents (ESAs) and postdialysis CV outcomes.
  
  
  METHODS
  The study analyzed claims data on incident hemodialysis patients aged > or = 18 years (identified between January 2000 and November 2005). Patients were identified as anemic and ESA-treated prior to dialysis. ESA treatment was categorized into 4 consistency groups (from least to most consistent ESA use).
  
  
  RESULTS
  Of 5,848 hemodialysis patients, 52% were identified as anemic prior to onset of dialysis. Predialysis ESA treatment was received by 62% of anemic patients, with only 23% receiving the most consistent treatment. The risk of a CV event was significantly lower for the ESA-treated compared with ESA-untreated patients (relative risk (RR) 0.70, 95% (95% confidence intervals (CI) 0.61 - 0.82)). Compared with ESA-untreated, those who received ESAs had significantly lower risk of acute myocardial infarction (RR 0.65 (95% CI 0.44 - 0.95)) or inpatient mortality (RR 0.52 (95% CI 0.40 - 0.68)). ESA-treated patients in each of the 4 consistency groups had significantly lower risk of CV events compared with ESA-untreated patients, with the greatest benefit seen in patients who received most consistent ESA (RR 0.61 (95% CI 0.48 - 0.76)).
  
  
  CONCLUSIONS
  This analysis suggests consistent ESA use to treat anemia of CKD in the predialysis period is associated with improved cardiovascular outcomes in postdialysis patients.
authors.affiliation: Department of Nephrology, Case Western Reserve University, Cleveland, OH 44106, USA. jaywish@earthlink.net
authors.forename: J B
authors.initials: JB
authors.lastname: Wish
authors.forename: G M
authors.initials: GM
authors.lastname: Nassar
authors.forename: K
authors.initials: K
authors.lastname: Schulman
authors.forename: M
authors.initials: M
authors.lastname: del Aguila
authors.forename: R
authors.initials: R
authors.lastname: Provenzano
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications* / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006397:Hematinics