title: Erythropoiesis-stimulating agent dosing, haemoglobin and ferritin levels in UK haemodialysis patients 2005-13.
abstract: Erythropoiesis-stimulating agents (ESAs) with intravenous iron supplementation are the main treatment for anaemia in patients with chronic kidney disease. Although observational studies suggest better outcomes for patients who achieve higher haemoglobin (Hb) levels, randomized controlled trials comparing higher and lower Hb targets have led to safety concerns over higher targets and to changes in treatment guidelines.
  
  
  
  Quarterly data from 2005 to 2013 were obtained on 28 936 haemodialysis patients from the UK Renal Registry. We examined trends in ESA use and average dose, Hb and ferritin values over time and Hb according to the UK Renal Association guideline range.
  
  
  
  The average ESA dose declined over time, with sharper decreases of epoetin seen towards the end of 2006 and from 2009. Average Hb for patients on ESAs was 114.1 g/L [95% confidence interval (CI) 113.7, 114.6] in the first quarter of 2005, which decreased to 109.6 g/L (95% CI 109.3, 109.9) by the end of 2013. Average serum ferritin was 353 µg/L (95% CI 345, 360) at the start of 2005, increasing to 386 µg/L (95% CI 380, 392) in the final quarter of 2013. The percentage of patients with Hb in the range of 100-120 g/L increased from 46.1 at the start of 2005 to 57.6 at the end of 2013.
  
  
  
  Anaemia management patterns for haemodialysis patients changed in the UK between 2005 and 2013. These patterns most likely reflect clinician response to emerging trial evidence and practice guidelines. Registries play an important role in continued observation of anaemia management and will monitor further changes as new evidence on optimal care emerges.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Birnie
authors.affiliation: School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK.|UK Renal Registry, Southmead Hospital, Bristol, UK.|Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
authors.forename: Fergus
authors.initials: F
authors.lastname: Caskey
authors.affiliation: School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Ben-Shlomo
authors.affiliation: School of Social and Community Medicine, University of Bristol, Clifton, Bristol, UK.
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.affiliation: UK Renal Registry, Southmead Hospital, Bristol, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Gilg
authors.affiliation: Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nitsch
authors.affiliation: Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Tomson
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004920:Erythropoiesis / Q000187:drug effects*; D005260:Female; D005293:Ferritins / Q000097:blood*; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D005293:Ferritins
keywords: ESA; anaemia management; erythropoiesis-stimulating agents; haemodialysis; haemoglobin