Epoetin alfa use in patients with ESRD: An analysis of recent US prescribing patterns and hemoglobin outcomes

Allan J. Collins, Robert M. Brenner, Joshua J. Ofman, Eric M. Chi, Nina Stuccio-White, Mahesh Krishnan, Craig Solid, Norma J. Ofsthun, J. Michael Lazarus

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

Background: It is unknown to what degree physicians adjust erythropoietin doses to achieve hemoglobin levels (11.0 to 12.0 g/dL [110 to 120 g/L]) recommended by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) for patients with end-stage renal disease receiving hemodialysis. Our objective is to examine epoetin alfa prescribing patterns for achieving the target hemoglobin level range in this population. Methods: Monthly hemoglobin levels and epoetin alfa doses from 2 large databases were retrospectively analyzed. One data set comprised 31,267 patients from the Fresenius Medical Care-North America (FMC-NA) database, and the other comprised 128,761 patients based on claims for Medicare services. Results: Longitudinal evaluation of the FMC-NA data set showed that hemoglobin levels in patients administered epoetin alfa cycled in and out of the NKF-K/DOQI hemoglobin target range, and doses were decreased in 98.8% of patients with persistent hemoglobin levels greater than 12.0 g/dL (>120 g/L). Hemoglobin levels in patients from the Medicare data set that initially were outside the target range migrated into the range with epoetin alfa dose titration. FMC-NA patients with a 3-month average hemoglobin level less than 11.0 g/dL (<110 g/L) were administered significantly greater epoetin alfa doses than those with average hemoglobin levels greater than 12.0 g/dL (>120 g/L; 21,838 versus 13,503 U/wk; P < 0.0001). Less than 0.4% of patients administered epoetin alfa were persistently anemic (hemoglobin < 11.0 g/dL [<110 g/L]) and were administered persistently high doses (>30,000 U/wk), but failed to respond with a 0.5-g/dL or greater (<5-g/L) increase in hemoglobin levels. Conclusion: In these analyses, few hemodialysis patients experienced persistent anemia while being administered high epoetin alfa doses. Physicians appeared to appropriately adjust doses to achieve hemoglobin levels recommended by the NKF-K/DOQI guidelines.

Original languageEnglish (US)
Pages (from-to)481-488
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume46
Issue number3
DOIs
StatePublished - Sep 2005

Bibliographical note

Funding Information:
Funding for the analysis described in this manuscript was provided by Amgen Inc, Thousand Oaks, CA.

Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.

Keywords

  • Anemia
  • End-stage renal disease (ESRD)
  • Epoetin alfa
  • Erythropoietin
  • Hemodialysis (HD)
  • Hemoglobin
  • Medicare
  • Reimbursement

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