Anaemia management in patients with chronic kidney disease: a position statement by the Anaemia Working Group of European Renal Best Practice (ERBP)

Locatelli, Francesco; Covic, Adrian; Eckardt, Kai‐Uwe; Wiȩcek, Andrzej; Vanholder, Raymond

doi:10.1093/ndt/gfn653

Cited by 199 publications

(185 citation statements)

References 40 publications

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“…In contrast, nonguideline position statements regarding anemia treatment in European patients with CKD released by the European Renal Best Practice (ERBP) group through 2010 generally suggested maintaining Hb levels between 11 and 12 g/dl. [29][30][31] In 2012, responding to new guidelines from the Kidney Disease Improving Global Outcomes group, 32 the ERBP group cited a lack of evidence of benefit or harm for maintaining Hb values in the range of 11.5 and 13.5 g/dl and suggested that Hb levels in European populations should be individualized between 10 and 12 g/dl. 33 Between 2010 and 2013, we have shown a steady increase in the proportion of European DOPPS facilities reporting a lower Hb target of 10 g/dl compared with 10.5 or 11 g/dl ( Figure 3B), with relatively little change in the proportion of facilities reporting an upper Hb target of 12 g/dl ( Figure 3A).…”

Section: Anemia Treatment Targets: 2010-2013mentioning

confidence: 99%

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

Fuller

Bieber

Pisoni

et al. 2015

JASN

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For years, erythropoiesis-stimulating agent (ESA) use among patients on dialysis was much higher in the United States than in Europe or Japan. Sweeping changes to dialysis reimbursement and regulatory policies for ESA in the United States in 2011 were expected to reduce ESA use and hemoglobin levels. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS) data from 7129 patients in 223 in-center hemodialysis facilities (average per month) to estimate and compare time trends in ESA dose and hemoglobin levels among patients on hemodialysis in the United States, Germany, Italy, Spain, the United Kingdom, and Japan. From 2010 to 2013, substantial declines in ESA use and hemoglobin levels occurred in the United States but not in other DOPPS countries. Between August of 2010 and April of 2013, mean weekly ESA dose in the United States decreased 40.4% for black patients and 38.0% for nonblack patients; mean hemoglobin decreased from 11.5 g/dl in black patients and 11.4 g/dl in nonblack patients to 10.6 g/dl in both groups. In 2010 and 2013, adjusted weekly ESA doses per kilogram were 41% and 11% lower, respectively, in patients in Europe and 60% and 18% lower, respectively, in patients in Japan than in nonblack patients in the United States. Adjusted hemoglobin levels in 2010 and 2013 were 0.07 g/dl lower and 0.56 g/dl higher, respectively, in patients in Europe and 0.93 and 0.01 g/dl lower, respectively, in patients in Japan than in nonblack patients in the United States. In conclusion, ESA dosing reductions in the United States likely reflect efforts in response to changes in reimbursement policy and regulatory guidance. 27: 220527: -221527: , 201627: . doi: 10.1681 Deficient renal erythropoietin production is a major factor contributing to the anemic status that affects the vast majority of patients on dialysis. 1 Treatment with erythropoiesis-stimulating agents (ESAs) and intravenous (iv) iron has been the cornerstone of anemia management for over two decades. 9 on the matter, data from the US Renal Data System were shared that indicated that more than one half of United States patients on dialysis had Hb levels above the US Food and Drug Administration 10 (FDA) target range of 10-12 g/dl, and the US Government Accounting Office 11 (GAO) presented a 2006 report recommending implementation of an expanded bundled payment for dialysis services including renal medications and laboratory services. Subsequent regulatory action culminated in three important changes that occurred in 2011. In January of 2011, the US Centers for Medicare and Medicaid Services (CMS) introduced a major modification to the ESRD Prospective Payment System (PPS) that was fully implemented nearly 90% of United States dialysis units, with the remainder opting to phase in over 4 years. The revised PPS added approximately $3 billion worth of separately billable services to the bundled payment, of which dose-based reimbursement for ESAs and iv iron accounted for approximately 67% and 8%, respectively. 12 In June of 2011, the FD...

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Section: Anemia Treatment Targets: 2010-2013mentioning

confidence: 99%

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

Fuller

Bieber

Pisoni

et al. 2015

JASN

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“…Vascular access thrombosis occurs with higher incidence [71,72] , although it is not found in other small studies [73,74] . The risk of serious cardiovascular events, such as thromboembolism and death, increases when hemoglobin levels increase rapidly (> 1 g/dL every 2 wk) [75] . The development of anti-EPO antibodies is a very rare but serious complication of treatment with erythropoietic agents.…”

Section: Side Effects Of Esasmentioning

confidence: 99%

“…The number of cases reported has dropped significantly from 2003, with none in 2007. This may have resulted from a change in the route of administration (at present the iv route is used in most patients on dialysis), maintenance of the cold chain, or elimination of uncoated rubber syringe stoppers [75] . Should this complication occur, clinical guidelines for diagnosis and treatment are readily available [81][82][83][84] .…”

Section: Side Effects Of Esasmentioning

confidence: 99%

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Use of agents stimulating erythropoiesis in digestive diseases

López¹,

Sicilia²,

García³

2009

WJG

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Anemia is the most common complication of inflammatory bowel disease (IBD). Control and inadequate treatment leads to a worse quality of life and increased morbidity and hospitalization. Blood loss, and to a lesser extent, malabsorption of iron are the main causes of iron deficiency in IBD. There is also a variable component of anemia related to chronic inflammation. The anemia of chronic renal failure has been treated for many years with recombinant human erythropoietin (rHuEPO), which significantly improves quality of life and survival. Subsequently, rHuEPO has been used progressively in other conditions that occur with anemia of chronic processes such as cancer, rheumatoid arthritis or IBD, and anemia associated with the treatment of hepatitis C virus. Erythropoietic agents complete the range of available therapeutic options for treatment of anemia associated with IBD, which begins by treating the basis of the inflammatory disease, along with intravenous iron therapy as first choice. In cases of resistance to treatment with iron, combined therapy with erythropoietic agents aims to achieve near-normal levels of hemoglobin/hematocrit (11-12 g/dL). New formulations of intravenous iron (iron carboxymaltose) and the new generation of erythropoietic agents (darbepoetin and continuous erythropoietin receptor activator) will allow better dosing with the same efficacy and safety.

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“…O objetivo do tratamento, de acordo com o protocolo, é manter a hemoglobina do paciente entre 11g/dL e 12g/ dL, e o hematócrito entre 33% e 36% 6 . Esses alvos terapêuticos também são preconizados pelo European Renal Association's Best Practice Guidelines (EBPG) e pelo Dialysis Outcomes Quality Initiative of the US National Kidney Foundation (NKF-DOQI) 15,16 . Níveis de hemoglobina acima de 12g/dL, de um modo geral, não são recomendados, pois há risco de propiciar a ocorrência de eventos cardiovasculares e de aumentar o risco de morte nos pacientes em tratamento dialítico 6,15,16 .…”

Section: Introductionunclassified

Utilização de eritropoetina por pacientes incidentes em hemodiálise no Sistema Único de Saúde, Brasil, 2002-2003

et al. 2012

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Este estudo visa a descrever o perfil demográfico e epidemiológico de pacientes incidentes em hemodiálise, que utilizaram eritropoetina em 2002 e 2003, no Brasil, e identificar fatores associados ao uso desse medicamento. Foram analisados dados demográficos, clínicos e relacionados à unidade de diálise de 32.136 pacientes, identificados por pareamento determinístico-probabilístico de dados do subsistema de autorização de procedimentos de alto custo e do Sistema de Informações sobre Mortalidade. Um modelo de regressão de Poisson foi usado para identificar fatores associados ao uso de eritropoetina. Sexo masculino; idade inferior a 65 anos; nefropatia diabética; fístula arteriovenosa ao iniciar hemodiálise e residir em outras Unidades Federativas diferentes do Mato Grosso foram fatores associados ao uso de eritropoetina. A política de atenção ao doente renal, a alocação de recursos para estados e municípios e o manejo da anemia, segundo o perfil farmacoterapêutico dos pacientes, devem ser revistos, a fim de reduzir as iniquidades observadas na utilização da eritropoetina.

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Anaemia management in patients with chronic kidney disease: a position statement by the Anaemia Working Group of European Renal Best Practice (ERBP)

Cited by 199 publications

References 40 publications

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

Use of agents stimulating erythropoiesis in digestive diseases

Utilização de eritropoetina por pacientes incidentes em hemodiálise no Sistema Único de Saúde, Brasil, 2002-2003

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