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Abstract
Background Currently, there is little uniformity in the management of the anaemia secondary to chronic kidney disease (CKD).
Purpose To analyse the use profile of erythropoiesis-stimulating agents (ESA) in the treatment of anaemia due to CKD in daily clinical practice, and to evaluate their effectiveness, safety, cost and the factors that influence resistance to these drugs.
Material and methods A descriptive, cross-sectional study was carried out in adult patients with anaemia due to CKD treated with ESA in the Outpatient Unit of a tertiary hospital. Patient characteristics according to the different ESAs (epoetin α/β, darbepoetin α and CERA) were analysed: effectiveness (optimal levels of Hb), safety (high levels of Hb) and cost (cost/patient-month according to dosage and ex-factory price). Equipotent doses of ESA and the factors that influence the resistance to these drugs were also evaluated.
Results 333 patients (23.4% epoetin α/β, 41.5% darbepoetin α and 35.1% CERA) were included. Patients treated with CERA had better values of serum creatinine, C-reactive protein, albumin and parathyroid hormone, and 94% of them were not on dialysis. The median (p25–p75) of Hb was 11.9 (11.1–12.7) g/dl and Hb level exceeded 13 g/dl in 16.5% of patients; no statistical differences were found between different ESAs. Median doses/patient-month were: epoetin α/β 12857 (8571–21714) IU, darbepoetin α 85.7 (42.9–128.6) mcg and CERA 75.0 (50.0–100.0) mcg. The need for higher doses and, thus, the associated cost varied depending on the type of patient: predialysis < functioning kidney transplant < dialysis. A low transferrin saturation index (TSI) was also correlated with higher doses of ESA.
Conclusion No differences in effectiveness or safety were found among different ESAs, although patients treated with CERA showed better clinical characteristics. Dialysis, renal transplantation and low TSI were the most important factors related to ESA resistance and, therefore, to its efficiency.
References And/or Acknowledgements
Pharmacy and Nephrology Departments
References And/or AcknowledgementsNo conflict of interest.