title: Trends in anemia care in older patients approaching end-stage renal disease in the United States (1995-2010).
abstract: OBJECTIVE
  Anemia is common in patients with advanced chronic kidney disease. Whereas the treatment of anemia in patients with end-stage renal disease (ESRD) has attracted considerable attention, relatively little is known about patterns and trends in the anemia care received by patients before they start maintenance dialysis or undergo preemptive kidney transplantation.
  
  
  OBJECTIVE
  To determine the trends in anemia treatment received by Medicare beneficiaries approaching ESRD.
  
  
  METHODS
  Closed cohort study in the United States using national ESRD registry data (US Renal Data System) of patients 67 years or older who initiated maintenance dialysis or underwent preemptive kidney transplantation between 1995 and 2010. All eligible patients had uninterrupted Medicare (A+B) coverage for at least 2 years before ESRD.
  
  
  METHODS
  Time, defined as calendar year of incident ESRD.
  
  
  METHODS
  Use of erythropoiesis-stimulating agents (ESA), intravenous iron supplements, and blood transfusions in the 2 years prior to ESRD; hemoglobin concentration at the time of ESRD. We used multivariable modified Poisson regression to estimate utilization prevalence ratios (PRs).
  
  
  RESULTS
  Records of 466,803 patients were analyzed. The proportion of patients with incident ESRD receiving any ESA in the 2 years before increased from 3.2% in 1995 to a peak of 40.8% in 2007; thereafter, ESA use decreased modestly to 35.0% in 2010 (compared with 1995; PR, 9.85 [95% CI, 9.04-10.74]). Among patients who received an ESA, median time from first recorded ESA use to ESRD increased from 120 days in 1995 to 337 days in 2010. Intravenous iron administration increased from 1.2% (1995) to 12.3% (2010; PR, 9.20 [95% CI, 7.97-10.61]). The proportion of patients receiving any blood transfusions increased monotonically from 20.6% (1995) to 40.3% (2010; PR, 1.88 [95% CI, 1.82-1.95]). Mean hemoglobin concentrations were 9.5 g/dL in 1995, increased to a peak of 10.3 g/dL in 2006, and then decreased moderately to 9.9 g/dL in 2010.
  
  
  CONCLUSIONS
  Between 1995 and 2010, older adults approaching ESRD were increasingly more likely to be treated with ESAs and to receive intravenous iron supplementation, but also more likely to receive blood transfusions.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.forename: Aya A
authors.initials: AA
authors.lastname: Mitani
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Goldstein
authors.forename: M Alan
authors.initials: MA
authors.lastname: Brookhart
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy / Q000209:etiology*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015331:Cohort Studies; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use*; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D015994:Incidence; D007501:Iron / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000628:therapy; D006278:Medicare; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D014481:United States
chemical_list: D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D006441:Hemoglobin A; D007501:Iron