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Gauthier-Loiselle M, Michalopoulos SN, Cloutier M, Serra E, Bungay R, Szabo E, Guérin A. Costs associated with the administration of erythropoiesis-stimulating agents for the treatment of anemia in patients with non-dialysis-dependent chronic kidney disease: a US societal perspective. J Manag Care Spec Pharm 2021; 27:1703-1713. [PMID: 34818094 PMCID: PMC10391171 DOI: 10.18553/jmcp.2021.27.12.1703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Erythropoiesis-stimulating agents (ESAs) are commonly used to treat anemia due to chronic kidney disease (CKD). In addition to drug acquisition costs, the administration of ESAs can include direct and indirect costs due to the needle-based route of administration (eg, time spent by health care staff administering therapy, and patients' and caregivers' time spent receiving or assisting with therapy). However, a comprehensive assessment of the costs associated with the administration of ESAs is lacking. OBJECTIVE: To estimate the excess costs associated with the needle-based administration of ESAs for the treatment of anemia due to non-dialysis-dependent (NDD) CKD in the United States in 2019 from a societal perspective. METHODS: Excess costs associated with ESA administration were estimated as the sum of annual costs that could be avoided with the introduction of an oral treatment with comparable safety and efficacy to ESAs. Cost components included direct health care costs, transportation costs, and work productivity loss costs from the perspective of both patients and caregivers (as applicable). Costs were estimated based on scientific publications, governmental agencies, and the results of a recent survey of US patients and caregivers of patients with anemia and CKD. The setting of the administration (ie, at home vs in clinic), frequency of administration, and insurance type were considered. RESULTS: At the societal level, annual excess costs associated with ESA administration were estimated at $2.5 billion in the United States in 2019, based on an estimated 462,005 patients with anemia and NDD-CKD treated with ESAs. Overall, 94.4% ($2.4 billion) of these costs were incurred from in-clinic ESA administration. When stratifying costs by insurance type, Medicare-insured patients accounted for 79.4% ($2.0 billion) of total annual excess costs. The largest contributor to total annual excess costs was direct health care costs ($1.4 billion, 54.9%), followed by patient work productivity loss costs ($846 million, 33.9%), caregiver work productivity loss costs ($197 million, 7.9%), and transportation costs ($81 million, 3.3%). Total annual excess costs of in-clinic administration ranged from $2,572 per patient receiving monthly administration to $20,948 per patient receiving thrice-weekly administration, while the total annual excess costs of at-home administration ranged from $1,123 per patient receiving monthly administration to $2,109 per patient receiving thrice-weekly administration. At the ESA administration level (ie, for each ESA administration), total excess costs were estimated at $128 per in-clinic ESA administration and $7 per at-home ESA administration, excluding monitoring costs. CONCLUSIONS: The needle-based administration of ESAs in patients with NDD-CKD is associated with a substantial economic burden. The introduction of an oral treatment has the potential to result in important cost savings from a societal perspective. DISCLOSURES: This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc., and Akebia Therapeutics, Inc. The study sponsors participated in the study design, data collection, analysis, interpretation of the data, writing of the report, and in the decision to submit the manuscript for publication. Gauthier-Loiselle, Cloutier, Serra, Bungay, and Guérin are employees of Analysis Group, Inc., a consulting firm that received funding from Otsuka Pharmaceutical Development & Commercialization, Inc., for the conduct of this study. Michalopoulos was an employee of Otsuka Pharmaceutical Development & Commercialization, Inc., at the time the study was conducted. Szabo is an employee of Akebia Therapeutics, Inc.
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Minutolo R, Berto P, Liberti ME, Peruzzu N, Borrelli S, Netti A, Garofalo C, Conte G, De Nicola L, Del Vecchio L, Locatelli F. Ferric Carboxymatose in Non-Hemodialysis CKD Patients: A Longitudinal Cohort Study. J Clin Med 2021; 10:jcm10061322. [PMID: 33806864 PMCID: PMC8005153 DOI: 10.3390/jcm10061322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 11/28/2022] Open
Abstract
No information is available on the efficacy of ferric carboxymaltose (FCM) in real-world CKD patients outside the hemodialysis setting. We prospectively followed 59 non-hemodialysis CKD patients with iron deficient anemia (IDA: hemoglobin <12.0/<13.5 g/dL in women/men and TSAT < 20% and/or ferritin < 100 ng/mL) who were intolerant or non-responders to oral iron. Patients received ferric carboxymaltose (FCM) (single dose of 500 mg) followed by additional doses if iron deficiency persisted. We evaluated efficacy of FCM in terms of increase of hemoglobin, ferritin, and TSAT levels. Direct and indirect costs of FCM were also analyzed in comparison with a hypothetical scenario where same amount of iron as ferric gluconate (FG) was administered intravenously. During the 24 weeks of study, 847 ± 428 mg of FCM per patient were administered. IDA improved after four weeks of FCM and remained stable thereafter. At week-24, mean change (95%CI) from baseline of hemoglobin, ferritin and TSAT were +1.16 g/dL (0.55–1.77), +104 ng/mL (40–168) and +9.5% (5.8–13.2), respectively. These changes were independent from ESA use and clinical setting (non-dialysis CKD, peritoneal dialysis and kidney transplant). Among ESA-treated patients (n = 24), ESA doses significantly decreased by 26% with treatment and stopped either temporarily or persistently in nine patients. FCM, compared to a FG-based scenario, was associated with a cost saving of 288 euros/patient/24 weeks. Saving was the same in ESA users/non-users. Therefore, in non-hemodialysis CKD patients, FCM effectively corrects IDA and allows remarkable cost savings in terms of societal, healthcare and patient perspective.
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Affiliation(s)
- Roberto Minutolo
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
- Correspondence: ; Tel./Fax: +39-081-2549409
| | | | - Maria Elena Liberti
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Nicola Peruzzu
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Silvio Borrelli
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Antonella Netti
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Carlo Garofalo
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Giuseppe Conte
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Luca De Nicola
- Division of Nephrology, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy; (M.E.L.); (N.P.); (S.B.); (A.N.); (C.G.); (G.C.); (L.D.N.)
| | - Lucia Del Vecchio
- Department of Nephrology and Dialysis, Sant’Anna Hospital, ASST Lariana, 22042 Como, Italy;
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Hanna RM, Streja E, Kalantar-Zadeh K. Burden of Anemia in Chronic Kidney Disease: Beyond Erythropoietin. Adv Ther 2021; 38:52-75. [PMID: 33123967 PMCID: PMC7854472 DOI: 10.1007/s12325-020-01524-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/03/2020] [Indexed: 02/08/2023]
Abstract
Anemia is a frequent comorbidity of chronic kidney disease (CKD) and is associated with a considerable burden because of decreased patient health-related quality of life and increased healthcare resource utilization. Based on observational data, anemia is associated with an increased risk of CKD progression, cardiovascular events, and all-cause mortality. The current standard of care includes oral or intravenous iron supplementation, erythropoiesis-stimulating agents, and red blood cell transfusion. However, each of these therapies has its own set of population-specific patient concerns, including increased risk of cardiovascular disease, thrombosis, and mortality. Patients receiving dialysis or those who have concurrent diabetes or high blood pressure may be at greater risk of developing these complications. In particular, treatment with high doses of erythropoiesis-stimulating agents has been associated with increased rates of hospitalization, cardiovascular events, and mortality. Resistance to erythropoiesis-stimulating agents remains a therapeutic challenge in a subset of patients. Hypoxia-inducible factor transcription factors, which regulate several genes involved in erythropoiesis and iron metabolism, can be stabilized by a new class of drugs that act as inhibitors of hypoxia-inducible factor prolyl-hydroxylase enzymes to promote erythropoiesis and elevate hemoglobin levels. Here, we review the burden of anemia of chronic kidney disease, the shortcomings of current standard of care, and the potential practical advantages of hypoxia-inducible factor prolyl-hydroxylase inhibitors in the treatment of patients with anemia of CKD.
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Affiliation(s)
- Ramy M Hanna
- Division of Nephrology, Hypertension and Kidney Transplantation, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Elani Streja
- Division of Nephrology and Hypertension, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California, Irvine School of Medicine, Orange, CA, USA.
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Efficacy and Safety of CKD-11101 (Proposed Biosimilar of Darbepoetin-Alfa) Compared with Darbepoetin-Alfa in Patients on Hemodialysis: A Randomized, Double-Blinded, Parallel-Group Phase III Study. BioDrugs 2020; 34:99-110. [PMID: 31749113 DOI: 10.1007/s40259-019-00396-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Darbepoetin-alfa is an erythropoiesis-stimulating agent (ESA) with a long elimination half-life that achieves better hemoglobin (Hb) stability than short-acting ESAs. OBJECTIVE We aimed to evaluate the efficacy and safety of intravenous CKD-11101 (a biosimilar of darbepoetin-alfa) compared with those of darbepoetin-alfa in hemodialysis patients. METHODS The study was performed in 24 centers in Korea between June 2015 and June 2017. The study subjects were randomized in a double-blind manner. The follow-up duration was 24 weeks, which consisted of 20 weeks of maintenance and 4 weeks of evaluation period. All patients underwent a stabilization period to achieve a target baseline Hb of 10-12 g/dL before randomization. Following randomization, patients received darbepoetin-alfa or CKD-11101 weekly or biweekly. RESULTS A total of 403 patients were randomized into two groups, and a total of 325 patients (80.6%) completed the investigation. The differences between the two groups in terms of change in the average Hb level from baseline to evaluation were not significant. The average administered dose of ESA was similar between the groups. There was no difference in the proportion of patients who maintained the target Hb during the evaluation period [60.4% vs. 66.2% in the CKD-11101 and darbepoetin-alfa groups, respectively (p = 0.3038)]. In addition, the safety analysis, consisting of adverse events and adverse drug reactions, showed comparable results between the two groups. CONCLUSION The changes in the level of Hb, dose of erythropoietin, and achievement rate of the target Hb during the study period were comparable between the groups. CKD-11101 has an equivalent efficacy and safety compared with darbepoetin-alfa in patients undergoing hemodialysis.
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Pergola PE, Pecoits-Filho R, Winkelmayer WC, Spinowitz B, Rochette S, Thompson-Leduc P, Lefebvre P, Shafai G, Bozas A, Sanon M, Krasa HB. Economic Burden and Health-Related Quality of Life Associated with Current Treatments for Anaemia in Patients with CKD not on Dialysis: A Systematic Review. PHARMACOECONOMICS - OPEN 2019; 3:463-478. [PMID: 30968369 PMCID: PMC6861396 DOI: 10.1007/s41669-019-0132-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND The cost and health-related quality of life (HRQoL) burden associated with treatments for anaemia of chronic kidney disease (CKD) is not well characterized among non-dialysis-dependent (NDD) patients. OBJECTIVE Our objective was to review the literature on costs and HRQoL associated with current treatments for anaemia of CKD among NDD patients. METHODS The Cochrane Library, MEDLINE, Embase, NHS EED, and NHS HTA databases were searched for original studies published in English between 1 January 2000 and 17 March 2017. The following inclusion criteria were applied: adult population; primary focus was anaemia of CKD; patients received iron supplementation, red blood cell transfusion, or erythropoiesis-stimulating agents (ESAs); and reported results on HRQoL and/or costs. Studies that included NDD patients, did not compare different treatments, and had relevant designs were retained. HRQoL and cost outcomes were summarized in a narrative synthesis. RESULTS In total, 16 studies met the inclusion criteria: six randomized controlled trials, four prospective single-arm trials, three retrospective studies, one prospective observational study, one simulation study, and one cross-sectional survey. All included ESAs. Treatment of anaemia (compared with no treatment) was associated with HRQoL improvements in five of six studies and lower costs in four of four studies. Treatment aiming for higher haemoglobin targets (compared with lower targets) resulted in modest HRQoL improvements, higher healthcare resource utilization (HRU), and higher costs. CONCLUSIONS In NDD patients, untreated anaemia of CKD leads to higher costs, higher HRU, and lower HRQoL compared with initiating anaemia treatment. Relative to aiming for lower haemoglobin targets with ESAs, higher targets conferred modest HRQoL improvements and were associated with higher HRU.
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Affiliation(s)
| | - Roberto Pecoits-Filho
- George Institute for Global Health, Newtown, NSW, Australia
- School of Medicine Pontificia, Universidade Catolica do Parana, Curitiba, PR, Brazil
| | | | | | - Samuel Rochette
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Philippe Thompson-Leduc
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada.
| | - Patrick Lefebvre
- Analysis Group, Inc., 1190 Avenue Des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | | | - Ana Bozas
- Akebia Therapeutics, Cambridge, MA, USA
| | - Myrlene Sanon
- Otsuka Pharmaceutical Development and Commercialization, Rockville, MD, USA
| | - Holly B Krasa
- Otsuka Pharmaceutical Development and Commercialization, Rockville, MD, USA
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Chow KM, Szeto CC, Choy ASM, Ng JKC, Mok AKW, Leung CB, Li PKT. Effect of Erythropoiesis-Stimulating Agent Therapy in Patients Receiving Palliative Care of Chronic Kidney Disease. Am J Hosp Palliat Care 2019; 36:718-721. [PMID: 30845809 DOI: 10.1177/1049909119834855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the increasing use of erythropoiesis-stimulating agent (ESA) in patients receiving dialysis, few studies have examined the benefits of ESA for patients with chronic kidney disease receiving palliative care. OBJECTIVE We designed a retrospective observational study to evaluate the effect of ESA in treating anemia of renal disease among adult patients receiving palliative care instead of dialysis. The primary objective was to assess whether ESA can reduce the transfusion burden and hospitalization. RESULTS Thirty-nine patients receiving ESA were matched with a control group of 39 patients without ESA. Their mean age and glomerular filtration rates were 76.7 (10.2) years and 11.6 (5.7) mL/min/1.73 m2, respectively. Baseline hemoglobin levels were comparable in the ESA and control groups; their corresponding values were 10.2 (1.5) and 10.1 (1.4) g/dL. During 1-year observation period, 34 units of red cell transfusion occurred in patients receiving ESA, whereas 128 units of red cell were transfused to patients in control group. Patients in the control group had higher transfusion rate (incidence rate ratio [IRR]: 3.63; 95% confidence interval [CI]: 2.49-5.31; P < .00001) and higher admission rates (IRR: 2.34; 95% CI: 1.80-3.03; P < .000001) than the ESA group even after adjustment for comorbidities. CONCLUSIONS High disease burden of palliative care among patients with stage 4 to 5 chronic kidney disease was reflected by transfusion requirement and hospitalization rates, both of which were shown to be significantly ameliorated by ESA treatment.
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Affiliation(s)
- Kai Ming Chow
- 1 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Cheuk Chun Szeto
- 1 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Agnes Shin Man Choy
- 1 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Jack Kit Chung Ng
- 1 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Alice Ka Wai Mok
- 2 Department of Medicine & Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Chi Bon Leung
- 1 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Philip Kam Tao Li
- 1 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong
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Patzer RE, Schrager JD, Pastan SO. Preventing Emergency Department Use among Patients with CKD: It Starts with Awareness. Clin J Am Soc Nephrol 2017; 12:225-227. [PMID: 28119411 PMCID: PMC5293343 DOI: 10.2215/cjn.12881216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Rachel E. Patzer
- Department of Surgery, Division of Transplantation
- Department of Medicine, Renal Division, and
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Justin D. Schrager
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; and
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Shih CJ, Chen YT, Ou SM, Yang WC, Kuo SC, Tarng DC. The impact of dialysis therapy on older patients with advanced chronic kidney disease: a nationwide population-based study. BMC Med 2014; 12:169. [PMID: 25315422 PMCID: PMC4189680 DOI: 10.1186/s12916-014-0169-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/01/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Older patients with advanced chronic kidney disease (CKD) face the decision of whether to undergo dialysis. Currently available data on this issue are limited because they were generated by small, short-term studies with statistical drawbacks. Further research is urgently needed to provide objective information for dialysis decision making in older patients with advanced CKD. METHODS This nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. Data from 2000 to 2010 were extracted. A total of 8,341 patients≥70 years old with advanced CKD and serum creatinine levels>6 mg/dl, who had been treated with erythropoiesis-stimulating agents were included. Cox proportional hazard models in which initiation of chronic dialysis was defined as the time-dependent covariate were used to calculate adjusted hazard ratios for mortality. The endpoint was all-cause mortality. RESULTS During a median follow-up period of 2.7 years, 6,292 (75.4%) older patients chose dialysis therapy and 2,049 (24.6%) received conservative care. Dialysis was initiated to treat kidney failure a median of 6.4 months after enrollment. Dialysis was associated with a 1.4-fold increased risk of mortality compared with conservative care (adjusted hazard ratio 1.39, 95% confidence interval 1.30 to 1.49). In subgroup analyses, the risk of mortality remained consistently increased, independent of age, sex and comorbidities. CONCLUSIONS In older patients, dialysis may be associated with increased mortality risk and healthcare cost compared with conservative care. For patients who are ≥70 years old with advanced CKD, decision making about whether to undergo dialysis should be weighted by consideration of risks and benefits.
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Affiliation(s)
- Chia-Jen Shih
- Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yung-Tai Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan.
| | - Shuo-Ming Ou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan. .,Institutes of Physiology and Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Wu-Chang Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
| | - Shu-Chen Kuo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan. .,Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Der-Cherng Tarng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan. .,Institutes of Physiology and Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Gurgel TC, Cherchiglia ML, Acurcio FDA, Szuster DAC, Gomes IC, Andrade EIG. [Erythropoietin use by incident hemodialysis patients in the Brazilian Unified National Health System, 2002-2003]. CAD SAUDE PUBLICA 2013; 28:856-68. [PMID: 22641509 DOI: 10.1590/s0102-311x2012000500005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/31/2012] [Indexed: 12/18/2022] Open
Abstract
This study aimed to describe the demographic and epidemiological profile of Brazilian patients entering hemodialysis from 2002 to 2003 and identify predictors of erythropoietin use. The study analyzed demographic and clinical characteristics and dialysis facility-related variables from 32,136 patients identified by deterministic-probabilistic matching in the database of authorizations for high-cost procedures and the Mortality Information System. Poisson regression was used to identify predictors of erythropoietin use. Male gender, age < 65 years, diabetic renal failure, arteriovenous fistula at the beginning of hemodialysis, and living in States of Brazil other than Mato Grosso were predictors of erythropoietin use. The policy of care for chronic kidney disease, resource allocation for States and municipalities, and anemia management according to the patient's drug therapy profile need to be revised in order to reduce observed inequities in erythropoietin use.
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Affiliation(s)
- Thaís Caroline Gurgel
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
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Dmitrieva O, de Lusignan S, Macdougall IC, Gallagher H, Tomson C, Harris K, Desombre T, Goldsmith D. Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data. BMC Nephrol 2013; 14:24. [PMID: 23351270 PMCID: PMC3626717 DOI: 10.1186/1471-2369-14-24] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 01/21/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease (CKD) may improve outcomes. However, little is known about the scope to improve primary care management of anaemia in CKD. METHODS An observational study (N = 1,099,292) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practices (ISRCTN5631023731). We explored variables associated with anaemia in CKD: eGFR, haemoglobin (Hb), mean corpuscular volume (MCV), iron status, cardiovascular comorbidities, and use of therapy which associated with gastrointestinal bleeding, oral iron and deprivation score. We developed a linear regression model to identify variables amenable to improved primary care management. RESULTS The prevalence of Stage 3-5 CKD was 6.76%. Hb was lower in CKD (13.2 g/dl) than without (13.7 g/dl). 22.2% of people with CKD had World Health Organization defined anaemia; 8.6% had Hb ≤ 11 g/dl; 3% Hb ≤ 10 g/dl; and 1% Hb ≤ 9 g/dl. Normocytic anaemia was present in 80.5% with Hb ≤ 11; 72.7% with Hb ≤ 10 g/dl; and 67.6% with Hb ≤ 9 g/dl; microcytic anaemia in 13.4% with Hb ≤ 11 g/dl; 20.8% with Hb ≤ 10 g/dl; and 24.9% where Hb ≤ 9 g/dl. 82.7% of people with microcytic and 58.8% with normocytic anaemia (Hb ≤ 11 g/dl) had a low ferritin (<100 ug/mL). Hypertension (67.2% vs. 54%) and diabetes (30.7% vs. 15.4%) were more prevalent in CKD and anaemia; 61% had been prescribed aspirin; 73% non-steroidal anti-inflammatory drugs (NSAIDs); 14.1% warfarin 12.4% clopidogrel; and 53.1% aspirin and NSAID. 56.3% of people with CKD and anaemia had been prescribed oral iron. The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been standardised. CONCLUSIONS Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron. Iron stores may be depleted in over >60% of people with normocytic anaemia. Prescribing oral iron has not corrected anaemia.
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Affiliation(s)
- Olga Dmitrieva
- Department of Health Care Management and Policy, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Iain C Macdougall
- Renal Medicine, Cheyne Wing, King’s College Hospital, London, SE5 9RS, UK
| | - Hugh Gallagher
- Epsom & St Helier University Hospitals NHS Trust SW Thames Renal Unit, St. Helier Hospital, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK
| | - Charles Tomson
- Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Kevin Harris
- University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Terry Desombre
- Department of Health Care Management and Policy, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - David Goldsmith
- Renal and Transplantation Department, Guy's Hospital, 6th Floor, Borough Wing, Great Maze Pond, London, SE1 9RT, UK
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Fishbane S, Roger SD, Martin E, Runyan G, O'Neil J, Qiu P, Locatelli F. Peginesatide for maintenance treatment of anemia in hemodialysis and nondialysis patients previously treated with darbepoetin alfa. Clin J Am Soc Nephrol 2012; 8:538-45. [PMID: 23243269 DOI: 10.2215/cjn.03440412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Peginesatide (Omontys) is a novel, synthetic, PEGylated, peptide-based erythropoiesis-stimulating agent (ESA) that is designed to specifically stimulate the erythropoietin receptor. This study evaluated maintenance of hemoglobin levels in patients after conversion from darbepoetin alfa to once-monthly peginesatide. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This open-label, multicenter study included 101 CKD patients, 52 of whom were receiving dialysis. The duration of the study was 24 weeks. The primary endpoint was the mean change in hemoglobin from baseline to the evaluation period (weeks 19-24). The study was conducted during the period from September 22, 2008 to December 24, 2009. RESULTS The mean change among hemodialysis patients was -0.42 g/dl (95% confidence interval, -0.65 to -0.19) and the mean change among CKD nondialysis patients was 0.49 g/dl (95% confidence interval, 0.26-0.71). The percentages of patients who maintained hemoglobin levels within ±1.0 g/dl of baseline values were as follows: 80.0% for hemodialysis and 68.1% for nondialysis, and73.3% for hemodialysis and 68.1% for nondialysis within the target range of 10.0-12.0 g/dl. Few patients received red blood cell transfusions (hemodialysis, 5.8%; nondialysis, 2.0%). Seventy-nine patients experienced adverse events, the majority of which were mild or moderate in severity. There were 40 serious adverse events and 2 deaths reported. CONCLUSIONS In this study, once-monthly peginesatide resulted in a slight decrease in mean hemoglobin levels in individuals on hemodialysis and a small increase in individuals with CKD who were not on dialysis.
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Affiliation(s)
- Steven Fishbane
- Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, NY 11021, USA.
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12
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Identification and management of chronic kidney disease complications by internal medicine residents: a national survey. Am J Ther 2012; 18:e40-7. [PMID: 19918169 DOI: 10.1097/mjt.0b013e3181bbf6fc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many patients with chronic kidney disease (CKD) receive care from primary care physicians. Identification and management of CKD complications in primary care is suboptimal. It is not known if current residency curriculum adequately prepares a future internist in this aspect of CKD care. We performed an online questionnaire survey of internal medicine residents in the United States to determine knowledge of CKD complications and their management. Four hundred seventy-nine residents completed the survey with postgraduate year (PGY) distribution 166 PGY1, 187 PGY2, and 126 PGY3. Most of the residents correctly recognized anemia (91%) and bone disease (82%) as complications at estimated glomerular filtration rate less than 60 mL/min/1.73 m; however, only half of the residents identified coronary artery disease (54%) as a CKD complication. For a patient with estimated glomerular filtration rate less than 60 mL/min/1.73 m, two thirds of the residents would workup for anemia (62%), whereas half of them would check for mineral and bone disorder (56%). With regard to anemia of CKD, less than half of the residents knew the CKD goal hemoglobin level of 11 to 12 g/dL (44%); most would supplement iron stores (86%), whereas fewer would consider nephrology referral (28%). For mineral and bone disorders, many residents would recommend dietary phosphorus restriction (68%) and check 25-hydroxyvitamin D (62%); fewer residents would start 1,25-dihydroxyvitamin D (40%) or refer to the nephrologist (45%). Residents chose to discontinue angiotensin-converting enzyme inhibitor for medication-related complication of greater than 50% decline in estimated glomerular filtration rate (68%) and potassium greater than 5.5 mEq/L (93%). Mean performance score improved with increasing PGY (PGY1 59.4% ± 17.6%, PGY2 63.6% ± 15.6%, and PGY3 66.2% ± 16.5%; P = 0.002). Our study identified specific gaps in knowledge of CKD complications and management among internal medicine residents. Educational efforts such as instruction on use of CKD clinical practice guidelines may help raise awareness of CKD complications, benefits of early intervention, and improve CKD management.
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Sabol VK, Resnick B, Galik E, Gruber-Baldini AL, Gonce Morton P, Hicks GE. Anemia Evaluation and Management in Nursing Home Residents. West J Nurs Res 2010; 32:447-61. [DOI: 10.1177/0193945909353899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anemia is often an unrecognized and/or undertreated diagnosis in older adults. Failure to diagnose anemia leads to delayed treatment and thus delayed relief of symptoms. Given the potentially significant impact of anemia on cardiovascular disease and physical performance among older nursing home (NH) residents, it is important to evaluate current clinical practice related to anemia.The purpose of this secondary data analysis was to evaluate the frequency of laboratory evaluation and medication treatment for anemia among older NH residents. Results indicated that more than half of NH residents were anemic at baseline, and of those, less than 20% had additional testing done to further evaluate for an underlying cause of their anemia and only 45.3% received any pharmacologic treatment. Future research is needed to clarify the potential benefits of timely diagnosis and appropriate treatment for anemic older adults in long-term-care settings and establish evidence-based guidelines to direct care in this area.
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Risk factors for high erythropoiesis stimulating agent resistance index in pre-dialysis chronic kidney disease patients, stages 4 and 5. Int Urol Nephrol 2010; 43:835-40. [DOI: 10.1007/s11255-010-9805-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 07/05/2010] [Indexed: 11/25/2022]
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Mau LW, Liu J, Qiu Y, Guo H, Ishani A, Arneson TJ, Gilbertson DT, Dunning SC, Collins AJ. Trends in Patient Characteristics and First-Year Medical Costs of Older Incident Hemodialysis Patients, 1995-2005. Am J Kidney Dis 2010; 55:549-57. [DOI: 10.1053/j.ajkd.2009.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 11/27/2009] [Indexed: 01/08/2023]
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16
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Resnick B, Sabol V, Galik E, Gruber-Baldini AL. The Impact of Anemia on Nursing Home Residents. Clin Nurs Res 2010; 19:113-30. [DOI: 10.1177/1054773810362089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this secondary data analysis was to describe the prevalence and treatment of anemia and test the impact of anemia on physical and psychosocial outcomes at baseline and following restorative care interventions. A total of 451 residents from 12 nursing homes participated in this study. The average age of the participants was 83.74 ( SD = 8.24), the majority were female (79%), White (66%), and unmarried (90%). A total of 245 (54%) residents were anemic, and 66% were treated with at least one medication. Physical performance was worse in those with anemia, and those with anemia associated with chronic kidney disease had lower self-efficacy and outcome expectations for functional activities than those without anemia. There was no time by treatment interaction between those with and without anemia. The findings provide some additional support for the prevalence of anemia and suggest that those with anemia associated with chronic kidney disease are less motivated to engage in functional activities.
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van Nooten FE, Green J, Brown R, Finkelstein FO, Wish J. Burden of illness for patients with non-dialysis chronic kidney disease and anemia in the United States: review of the literature. J Med Econ 2010; 13:241-56. [PMID: 20438399 DOI: 10.3111/13696998.2010.484307] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the health-related quality of life (HRQL) and economic burden of chronic kidney disease (CKD) related anemia in non-dialysis patients in the United States (US) via literature review. METHODS MEDLINE, EMBASE, PROQOLID, and Cochrane Library/Renal Group Resources were searched. Studies were appraised for patient populations, disease-specific versus generic HRQL assessments, and type and magnitude of health-related costs. RESULTS The treatment costs for CKD patients with anemia compared to those without anemia were significantly higher and were blunted but persistent after controlling for comorbidities and confounders. Intervention with erythropoiesis stimulating agents (ESA) decreased anemia and avoided hospital admissions. Costs were higher when anemia was poorly controlled or untreated. HRQL burden was mainly due to physical limitations and difficulty in ability to perform activities of daily living. Significant positive correlations between increases in hemoglobin levels and HRQL measures were reported. CONCLUSIONS Although evidence is limited, the economic and HRQL burden of non-dialysis CKD-related anemia is substantial. Under-treatment of anemia may contribute to higher resource consumption and higher costs; however, patient co-morbidities, use of erythropoietin-stimulating agents, and overall management introduce potential confounds. The contribution of anemia to humanistic disease burden is due to a constellation of factors, including physical activity and functional status.
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Affiliation(s)
- Floortje E van Nooten
- Centre for Health Economics & Science Policy, United BioSource Corporation, 20 Bloomsbury Square, London, UK.
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18
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Abstract
Chronic kidney disease (CKD) is a widespread health problem in the world and anemia is a common complication. Anemia conveys significant risk for cardiovascular disease, faster progression of renal failure and decreased quality of life. Patients with CKD can have anemia for many reasons, including but not invariably their renal insufficiency. These patients require a thorough evaluation to identify and correct causes of anemia other than erythropoietin deficiency. The mainstay of treatment of anemia secondary to CKD has become erythropoiesis-stimulating agents (ESAs). The use of ESAs does carry risks and these agents need to be used judiciously. Iron deficiency often co-exists in this population and must be evaluated and treated. Correction of iron deficiency can improve anemia and reduce ESA requirements. Partial, but not complete, correction of anemia is associated with improved outcomes in patients with CKD.
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Affiliation(s)
- Christina E Lankhorst
- Division of Nephrology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
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Rasu RS, Jayawant SS, Abercrombie M, Balkrishnan R. Treatment of anemia among women with chronic kidney disease in United States outpatient settings. Womens Health Issues 2009; 19:211-9. [PMID: 19447325 DOI: 10.1016/j.whi.2009.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 01/18/2009] [Accepted: 03/16/2009] [Indexed: 01/22/2023]
Abstract
AIMS Women with chronic kidney disease (CKD) are often at risk for anemia. This study examined variations in anemia care and management among women with CKD in outpatient settings in the United States. METHODS The study utilized National Ambulatory Medical Care Survey (NAMCS) data from 1996 to 2003. Women aged 18 years or older with CKD were included based on ICD-9-CM codes for CKD, anemia, and reason for visit. Anemia-related medications were retrieved using NAMCS drug codes. RESULTS Approximately 58 million weighted outpatient visits for women with CKD were made. Nearly 14% of these visits were by Hispanic women and 50% visits were by patients aged 65 years or older. Nephrologists accounted for only 15% of CKD patient visits and 51% of these patients had anemia diagnosis. Additionally, 32% of patients were using 5 or more medications. Women with Medicare coverage were 2.6 times more likely (p < .05) to be diagnosed with anemia by a nephrologist and were 2.4 times more likely (p < .05) to receive a prescription to treat anemia than patients seen by non-nephrologists. Hispanic women were 56% less likely (p < or = .05) to use 5 or more medications than non-Hispanic patients. CKD patients with anemia diagnosis were 50% less likely to receive 5 or more medications (p < or = .05). CONCLUSION This study found many risk factors associated with the diagnosis and treatment of anemia in women with CKD being treated in U.S. outpatient settings. Increased awareness of early treatments for anemia and assessments of patients receiving multiple medications is needed in women with CKD.
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Affiliation(s)
- Rafia S Rasu
- School of Pharmacy, University of Missouri--Kansas City, Kansas City, Missouri 64108, USA.
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Curran MP, McCormack PL. Methoxy polyethylene glycol-epoetin beta: a review of its use in the management of anaemia associated with chronic kidney disease. Drugs 2008; 68:1139-56. [PMID: 18484803 DOI: 10.2165/00003495-200868080-00009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Methoxy polyethylene glycol-epoetin beta (Mircera) is a continuous erythropoietin receptor activator, with a long half-life (approximately 130 hours). In patients with anaemia associated with chronic kidney disease (CKD), both on and not on dialysis, who had not previously received an erythropoiesis-stimulating agent (ESA), methoxy polyethylene glycol-epoetin beta administered intravenously or subcutaneously once every 2 weeks resulted in a smooth and steady rise in haemoglobin levels. The response rates were high (up to 97.5%) in these patients at the end of the correction period; response rates with the comparator ESAs (epoetin alfa or beta, or darbepoetin alfa) were up to 96.3%. Moreover, patients with CKD on dialysis who had previously been treated with an ESA maintained stable haemoglobin levels (within +/-1 g/dL of baseline and within a range of 10-13.5 g/dL) when directly converted to methoxy polyethylene glycol-epoetin beta administered intravenously or subcutaneously once every 2 or 4 weeks. Methoxy polyethylene glycol-epoetin beta is generally well tolerated, with most adverse events being of mild to moderate severity, consistent with the co-morbidities known to occur in this patient group and those reported with other ESAs. In conclusion, in patients with anaemia associated with CKD, subcutaneous or intravenous methoxy polyethylene glycol-epoetin beta achieved a high haemoglobin response rate (ESA-naive patients) when administered once every 2 weeks and maintained stable haemoglobin levels (patients previously treated with ESAs) when administered once monthly.
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