title: Restricted Use of Erythropoiesis-Stimulating Agent is Safe and Associated with Deferred Dialysis Initiation in Stage 5 Chronic Kidney Disease.
abstract: The effect of erythropoiesis-stimulating agent (ESA) on dialysis initiation in advanced chronic kidney disease (CKD) patients is not clear. We retrospectively analyzed the outcome of dialysis initiation in a stage 5 CKD cohort with ESA reimbursement limited to the maximal standardized monthly ESA dose equivalent to epoetin beta 20,000 U by the National Health Insurance program. Totally 423 patients were followed up for a median of 1.37 year. A time-dependent Cox regression model, adjusted for monthly levels of estimated glomerular filtration rate (eGFR) and hemoglobin, was constructed to investigate the association between ESA and outcome. The standardized monthly ESA dose in ESA users was 16,000 ± 3,900 U of epoetin beta. Annual changes of hemoglobin were -0.29 ± 2.19 and -0.99 ± 2.46 g/dL in ESA users and ESA non-users, respectively (P = 0.038). However, annual eGFR decline rates were not different between ESA users and non-users. After adjustment, ESA use was associated with deferred dialysis initiation (hazard ratio 0.63, 95% confidence interval 0.42-0.93, P = 0.021). The protective effect remained when the monthly ESA doses were incorporated. Our data showed that restricted use of ESA was safe and associated with deferred dialysis initiation in stage 5 CKD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.|Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Szu-Yu
authors.initials: SY
authors.lastname: Pan
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Chiang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ping-Min
authors.initials: PM
authors.lastname: Chen
authors.affiliation: Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Heng-Hsiu
authors.initials: HH
authors.lastname: Liu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Chou
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan.
authors.forename: Tai-Shuan
authors.initials: TS
authors.lastname: Lai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Chiu
authors.affiliation: Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan.|Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Wan-Yu
authors.initials: WY
authors.lastname: Lin
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yung-Ming
authors.initials: YM
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Tzong-Shinn
authors.initials: TS
authors.lastname: Chu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.|Department of Integrated Diagnostics &Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.|Research Center for Development Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Shuei-Liong
authors.initials: SL
authors.lastname: Lin
mesh_terms: D000368:Aged; D003956:Dialysis / Q000706:statistics & numerical data*; D005260:Female; D005919:Glomerular Filtration Rate; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006397:Hematinics