Anemia Management During Early HD Varies By Country

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US patients receive higher intravenous iron and ESA doses during the first year of hemodialysis compared with those in Europe.
US patients receive higher intravenous iron and ESA doses during the first year of hemodialysis compared with those in Europe.

Researchers have identified international differences in anemia management during the early period following hemodialysis (HD) initiation that possibly have clinical implications.

Angelo Karaboyas, MS, of Arbor Research Collaborative for Health in Michigan, and colleagues analyzed data from 6612 HD patients treated 2012–2015 who participated in phase 5 of DOPPS (Dialysis Outcomes and Practice Patterns Study). Results showed that patients in the United States received higher doses of intravenous (IV) iron and erythropoiesis-stimulating agents (ESA) during the first year of HD than their counterparts in Europe. Yet their average hemoglobin levels were lower.

Iron parameters rose more quickly in US patients, reaching a sustained level of 900 ng/mL ferritin and 32% transferrin saturation (TSAT), on average, after 2 years, even as IV iron doses moderated to similar milligrams per month prescribed in European countries including Belgium, Germany, Italy, Spain, Sweden, and the United Kingdom. In Japan, ESA and IV iron dosing and the trajectory of ferritin and TSAT levels were more stable in the first 5 years of HD.

“Because early HD mortality is high, future investigation is needed including identifying pre-HD practices that can support the use of lower IV iron and ESA doses soon after HD start, and what effect if any this might have on clinical outcomes,” Karaboyas and colleagues stated in a study abstract.

The study was funded by various pharmaceutical companies.

Reference

Karaboyas A, Robinson BM, Meier Y, Loram L, Inaba M, Jacobson SH, Vanholder RC, Pisoni RL. Anemia and Iron Management over the First 5 Years after Dialysis Start: Results from the DOPPS. Presented at: Kidney Week 2016. November 15-20, 2016. Chicago. Abstract SA-OR110.

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