Patients Weigh Anemia Management Options
In a survey, hemodialysis patients were willing to accept medication risks to avoid red blood cell transfusion.
Not only can hemodialysis patients understand the risks and benefits associated with anemia treatments, they make compromises and have preferences that are important to understand for shared decision-making.
Brett Hauber, PhD, of RTI Health Solutions in Research Triangle Park, North Carolina, and his team surveyed 200 HD patients from the National Kidney Foundation's member database on their anemia management preferences. Four out of 5 respondents had ever received an anemia diagnosis. The online questionnaire asked respondents to choose between two hypothetical medications based on symptom relief, number of red blood cell transfusions, cardiovascular risk, route of administration, and out-of-pocket costs. While their responses cannot be generalized to all HD patients, they offer a window into the aspects of care that patients deem important. Here are some highlights:
- Patients were willing to accept a 6% medication-related risk of dying from a heart attack to avoid having 2 red blood cell transfusions per month. One in 5 patients had ever experienced a heart attack or stroke.
- Going from 2 to 1 transfusions per month was twice as important as going from 1 to 0.
- Medications delivered into the dialysis line were preferred over subcutaneous injection. Patients would pay an extra $63 to receive medication that way. Sixty-four percent of respondents typically received anemia medication with dialysis.
- To increase symptom relief from 25% to 75%, patients would accept 1.7 transfusions or a 4.5% risk of heart attack from medications or pay an additional $94.
- Lung injury was the top transfusion-related risk patients wanted to avoid, and outranked infection, future allograft rejection, medication-related cardiovascular risk, longer wait for transplant, allergic reaction, and transportation hassles.
“Our results suggest that physicians can engage patients in discussions of anemia management,” Dr Hauber and colleagues wrote in BMC Nephrology. “Understanding patients' preferences for anemia treatments, including transfusions and treatments to reduce the need for transfusion, and patients' willingness to trade off among the benefits and risks of these treatments may help guide providers toward care that better aligns with patients' preferences.”
The study was funded by Amgen Inc., of Thousand Oaks, California.
Hauber B, Caloyeras J, Posner J, Brommage D, Tzivelekis S, and Pollock A. Hemodialysis patients' preferences for the management of anemia. BMC Nephrol. doi: 10.1186/s12882-017-0664-9