title: Erythropoiesis-stimulating Agents and Anemia in Patients with Non-dialytic Chronic Kidney Disease.
abstract: Anemia is common in patients with advanced chronic kidney disease (CKD). Though erythropoiesis-stimulating agents (ESAs) have been strongly endorsed in guidelines, it is of particular financial interest. Recently, the reimbursement of ESAs in non-dialytic patients was started by the Korean National Health Insurance System. Thus, we investigated the impact of the reimbursement of ESAs on the anemia care in non-dialytic CKD patients. Medical records of patients with advanced CKD (estimated GFR <30 mL/min/1.73 m(2)) were reviewed. Use of ESAs, blood transfusion, and hemoglobin concentrations were analyzed from one year prior to reimbursement to three years following. We used multivariable modified Poisson regression to estimate the utilization prevalence ratio (PRs). A total of 1,791 medical records were analyzed. The proportion of patients receiving ESAs increased from 14.8% before reimbursement to a peak 33.6% in 1 yr after reimbursement; thereafter, ESA use decreased to 22.4% in 3 yr after reimbursement (compared with baseline; PR, 2.19 [95% CI, 1.40-3.42]). In patients with Hb <10 g/dL, the proportion of receiving ESAs increased from 32.1% before reimbursement to 66.7% in 3 yr after reimbursement (compared with baseline; PR, 2.04 [95% CI, 1.25-3.32]). Mean hemoglobin concentrations were 10.06±1.54 g/dL before reimbursement and increased to 10.78±1.51 g/dL in 3 yr after the reimbursement change (P=0.001). However, the requirement of blood transfusion was not changed over time. With the reimbursement of ESAs, the advanced CKD patients were more likely to be treated with ESAs, and the hemoglobin concentrations increased.
authors.affiliation: Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
authors.forename: Sun Moon
authors.identifier: 0000-0003-2010-4440
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
authors.forename: Kyeong Min
authors.identifier: 0000-0002-5414-4339
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.; Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Soon Kil
authors.identifier: 0000-0001-9287-4490
authors.initials: SK
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.; Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
authors.forename: Hye-Young
authors.identifier: 0000-0003-4102-5135
authors.initials: HY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D001803:Blood Transfusion; D005260:Female; D005919:Glomerular Filtration Rate; D006397:Hematinics / Q000627:therapeutic use*; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D016012:Poisson Distribution; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006397:Hematinics; D006454:Hemoglobins
keywords: Anemia; Blood Transfusion; Erythropoietin; Renal Insufficiency, Chronic