ESA Use Declining at Hospital-Based Dialysis Centers

ATLANTA—Hospital-based dialysis centers have changed their anemia management practices since 2010, with continuing declines in erythropoiesis stimulating agents (ESAs), higher doses of intravenous (IV) iron, and declining hemoglobin levels, researchers reported at the American Society of Nephrology's Kidney Week 2013 meeting.

The trend, which is consistent with previously reported national data, followed changes in prescribing information for ESAs and the debut in January 2011 of a prospective payment system (“bundling”) for dialysis services.

George N. Coritsidis, MD, of the New York City Health and Hospitals Corp. in New York, and colleagues analyzed the electronic medical records of 5,404 hemodialysis patients in 50 hospital-based dialysis centers in the U.S. from January 2010 to March 2013. Most patients received darbepoetin alfa.

During the study period, the median cumulative four-week dose of the medication dropped 41% from 170 to 100 mcg. The median cumulative four-week intravenous iron dose rose 50% from 250 to 375 mg. The mean monthly hemoglobin (Hb) level decreased from 11.4 to 10.7 g/dL and the percent of patients with mean monthly Hb levels below 10 increased from 11.3% to 24.4%. The percent of patients with mean monthly Hb levels above 12 decreased from 30.1% to 11.2%.

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