The Impact of Lowering Haemoglobin Targets on Patterns of Erythropoiesis-Stimulating Agent Use in Patients on Haemodialysis

Abstract

Background/Aims: Haemoglobin (Hb) targets have been reduced in patients receiving haemodialysis (HD). We have investigated the impact of new guidance on current practices and costs. Methods: Anaemia management in all patients undergoing thrice-weekly HD was retrospectively reviewed. Hb targets were compared against Kidney Disease: Improving Global Outcomes 2012 recommendations. The impact of new guidance was assessed by comparing anaemia parameters pre- and post-guideline publication. Results: Two hundred and ninety two patients, with a mean age of 64 years were included. The Hb target range was achieved in 44% patients and was above target in 51%. In a sub-group of 230 patients, the mean Hb did not differ during Q4-2011 and Q4-2012. A reduction in erythropoiesis-stimulating agent (ESA) use was observed. ESA efficiency (Hb/ESA) increased in the later period (6.08 vs. 6.41 g/l/μg) and was associated with a 3% cost reduction. Conclusion: Introduction of guidelines lowering Hb targets in HD patients led to more efficient ESA usage and cost-savings. Anaemia treatment, however, remains unnecessarily aggressive in some patients. Further reductions in Hb and ESA dose are achievable.

Economic and quality of life burden of anemia on patients with CKD on dialysis: a systematic review

“…Table 1 presents the characteristics of the included studies. Study designs included four (26.7%) RCTs [46][47][48][49] , four (26.7%) retrospective studies [50][51][52][53] , three (20.0%) simulation studies [54][55][56] , two (13.3%) cross-sectional surveys 57,58 , and two (13.3%) prospective single-arm trials (Figure 2) 59,60 . Six (40.0%) studies were real-world studies (non-simulated, noninterventional) [50][51][52][53]57,58 , including three (50.0%) 51,57,58 published after 2012.…”

“…Study designs included four (26.7%) RCTs [46][47][48][49] , four (26.7%) retrospective studies [50][51][52][53] , three (20.0%) simulation studies [54][55][56] , two (13.3%) cross-sectional surveys 57,58 , and two (13.3%) prospective single-arm trials (Figure 2) 59,60 . Six (40.0%) studies were real-world studies (non-simulated, noninterventional) [50][51][52][53]57,58 , including three (50.0%) 51,57,58 published after 2012. Two publications were derived from the same study (included the same patients), but reported different results (different HRQoL instruments were used) 47,48 .…”

“…Four (26.7%) articles reported exclusively on costs [51][52][53]55 , eight (53.3%) reported on HRQoL only [46][47][48][49][50][57][58][59] , and three (20.0%) reported on both costs and HRQoL 54,56,60 .…”

“…Seven out of 15 (46.7%) studies were conducted in North America exclusively 47,48,[52][53][54][55][56] , four (26.7%) were conducted in Europe exclusively 46,51,57,60 , and four (26.7%) were conducted elsewhere (including international collaborations; Figure 3) 49,50,58,59 . Among the seven studies that reported cost outcomes, five (71.4%) were conducted in North America exclusively [52][53][54][55][56] , and two (28.6%) in Europe exclusively 51,60 .…”

“…Seven out of 15 (46.7%) studies were conducted in North America exclusively 47,48,[52][53][54][55][56] , four (26.7%) were conducted in Europe exclusively 46,51,57,60 , and four (26.7%) were conducted elsewhere (including international collaborations; Figure 3) 49,50,58,59 . Among the seven studies that reported cost outcomes, five (71.4%) were conducted in North America exclusively [52][53][54][55][56] , and two (28.6%) in Europe exclusively 51,60 . Among the 11 studies that reported HRQoL outcomes, four (36.4%) were conducted in North America exclusively 47,48,54,56 , three (27.3%) in Europe exclusively 46,57,60 , and four (36.4%) were conducted elsewhere (including international collaborations; Table 1) 49,50,58,59 .…”