Predictors of ESA use in the non-dialysis chronic kidney disease population with anemia.
BACKGROUND
Anemia is a common complication of chronic kidney disease (CKD), but anemia treatment may be less comprehensive than guidelines suggest.


METHODS
The study population (n = 11,754) included general Medicare recipients with Parts A and B coverage before January 1, 2001, aged > or =65 years on January 1, 2001, and alive with Medicare as primary payer through December 31, 2001. Time-dependent proportional hazards models were used to investigate predictors of erythropoiesis-stimulating agent (ESA) use, adjusted for comorbid conditions and severity-of-disease variables as time-dependent, and age, sex, and race as fixed variables. ESA use was defined during 2002 and time-dependent variables during 2001-2002.


RESULTS
Only 839 patients (7%) received ESAs. Characteristics significantly predictive of ESA use (p < 0.05) were: outpatient specialty services, nephrology and hematology/oncology/medical oncology (RR 6.92); outpatient specialty services, hematology/oncology/medical oncology (RR 6.02); outpatient specialty services, nephrology (RR 3.44); inpatient principle procedure, other operations on vessels (RR 1.68); transfusions (RR 1.54), hypertension (RR 1.50); congestive heart failure (RR 1.34); home oxygen (RR 1.28).


CONCLUSIONS
Access to anemia treatment may be an important marker for access to CKD care. Clinical trials are needed to assess effects of early referral and more comprehensive anemia treatment.
Collins
Allan J
AJ
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minn. 55404, USA. acollins@cdrg.org
Guo
Haifeng
H
Gilbertson
David T
DT
Bradbury
Brian D
BD
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D011237:Predictive Value of Tests; D006435:Renal Dialysis
D006397:Hematinics