NDLI: Timing of erythropoiesis-stimulating agent initiation and adverse outcomes in nondialysis CKD: a propensity-matched observational study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Seliger, Stephen Fox, Kathleen M. Gandra, Shravanthi R. Bradbury, Brian Hsu, Van Doren Walker, Loreen Chiou, Chiun-Fang Fink, Jeffrey C.
Description	Country affiliation: United States Author Affiliation: Seliger S ( Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA. sseliger@medicine.umaryland.edu)
Abstract	BACKGROUND AND OBJECTIVES: The severity of anemia at which to initiate erythropoiesis-stimulating agent (ESA) treatment in nondialysis chronic kidney disease (CKD) patients is unclear. Risk of mortality, hospitalizations, and blood transfusion were compared among nondialysis CKD patients with 'early' versus 'delayed' ESA initiation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective cohort study was conducted on CKD (estimated GFR <60 ml/min/1.73m(2)) outpatients in the national Veterans Administration who were initiated on ESAs. Patients with ESRD, gastrointestinal bleeding, chemotherapy, or hematologic malignancy were excluded. Patients were characterized as having early [hemoglobin (Hb) 10.0 to 11.0 g/dl] or delayed (Hb 8.0 to 9.9 g/dl) ESA initiation. A propensity score comprising demographic, clinical, and laboratory variables was used to select a 1:1 matched cohort. Cox survival and negative binomial regression were used to compare the matched groups for all-cause mortality, hospitalizations, and blood transfusions. RESULTS: Of 1837 patients who met inclusion criteria, 1410 (77%) were successfully matched. The groups did not differ significantly in 31 characteristics reflecting sociodemographics, comorbidity, healthcare utilization, and renal function. There was no significant difference in mortality with early initiation. Those initiated early had a 17% lower risk of initial hospitalization and a 29% lower risk of transfusion compared with delayed initiation patients. Results did not differ between those with and without pre-ESA transfusion or hospitalization. CONCLUSIONS: In nondialysis CKD, ESA initiation at Hb 10.0 to 11.0 g/dl compared with 8.0 to 9.9 g/dl is associated with reduced risk of blood transfusion and initial hospitalization.
File Format	HTM / HTML
ISSN	15559041
e-ISSN	1555905X
DOI	10.2215/CJN.07171009
Journal	Clinical Journal of the American Society of Nephrology
Issue Number	5
Volume Number	5
Language	English
Publisher	American Society of Nephrology
Publisher Date	2010-05-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Erythropoiesis Chi-square Distribution Kaplan-meier Estimate Kidney Diseases Research Support, Non-u.s. Gov't Comparative Study Biological Markers Blood Blood Transfusion Time Factors Etiology Retrospective Studies Hemoglobins Hematinics Drug Administration Schedule Risk Assessment Anemia Complications Mortality Risk Factors Drug Therapy Proportional Hazards Models Discipline Nephrology Logistic Models Administration & Dosage Hospitalization Metabolism Drug Effects Ambulatory Care Propensity Score Chronic Disease
Content Type	Text
Resource Type	Article
Subject	Transplantation Critical Care and Intensive Care Medicine Nephrology Epidemiology

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