title: Predictors of erythropoietin use in patients with cardiorenal anaemia syndrome.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) and anemia are common in patients with heart failure (HF) - these 3 conditions have been coined the Cardiorenal Anemia Sydrome (CRAS). The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines do not specifically address patients with CRAS, creating uncertainty in erythropoietin (EPO) prescribing. We sought to determine predictors of EPO use in patients with CRAS.
  
  
  METHODS
  We conducted a retrospective cohort study at the Veteran's Affairs Greater Los Angeles Healthcare System (VAGLAHS), a 300+ bed facility that provides primary and tertiary inpatient, and ambulatory care services, between January 1, 2003 to December 31, 2006. A multiple logistic regression model was constructed to identify predictors of EPO use among CRAS patients.
  
  
  RESULTS
  Of 2058 patients with CRAS, 213 (10.3%) were prescribed EPO. There were significant differences in baseline characteristics between the EPO and non-EPO groups. The following predictors were found to be associated with EPO prescription: iron supplementation (odds ratio [OR] 52.70, 95% confidence interval [CI] 11.70-237.46), renal clinic appointment (OR 2.60, 95% CI 1.79-3.76), malignancy (OR 1.52, 95% CI 1.07-2.16) and use of hydralazine/nitrates (OR 1.41, 95% CI 1.03-1.92). There was an inverse association found between EPO prescription and baseline hemoglobin (OR 0.61, 95% CI 0.53-0.70) and eGFR (OR 0.96, 95% CI 0.94-0.97).
  
  
  CONCLUSIONS
  A small proportion of patients eligible for EPO therapy according to guidelines at the time of the study were prescribed the indicated therapy. Markers of declining renal function or those suggesting need for anemia therapy were identified as EPO predictors.
authors.affiliation: Pharmacy Practice and Administration Department, Western University of Health Sciences, Pomona, CA, USA; Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada; Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Jackevicius
authors.forename: Mary Joana
authors.initials: MJ
authors.lastname: Co
authors.forename: Alberta L
authors.initials: AL
authors.lastname: Warner
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy*; D059347:Cardio-Renal Syndrome / Q000188:drug therapy*; D015331:Cohort Studies; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D004921:Erythropoietin
keywords: CRAS; anaemia; anaemia of chronic kidney disease; congestive heart failure; kidney failure