Effectiveness and Safety Study of the Stimulating Agents of Erythropoyesis in the Treatment of Anemia Associated with Chronic Kidney Disease. Analysis of the Factors that Influence the Response
Keywords:
Epoetin beta, Darbepoetin alfa, Anemia, Kidney failure, chronic TreatmentAbstract
Objective: To evaluate the effectiveness and safety of darbepoetin α and epoetin β in anemia associated with CKD and to study the factors that influence the response.
Methods: It was carried out an observational, group and retrospective study. Patients ≥18 years of age with CKD who started treatment with ESA between January 1, 2014 and December 31, 2015. Maximum period of follow-up: 24 months. Sociodemographic, analytical, effectiveness and related to the cause of end of follow-up variables. Statistical analysis: multivariate logistic regression models, multiple linear regression. The study obtained a favorable opinion from the Aragón Clinical Research Ethics Committee (CEICA).
Results: 198 patients: 59.1% men, mean age: 75.3 ± 12.4 years, 60% stage 4 CKD, mean baseline Hb: 10.2 ± 1.3 g / dL. 71.2% started darbepoetin α (median dose: 18.7 (4.7-100.0) µg / weekly), 28.8% epoetin β (6000.0 (466.7-20,000.0) IU /weekly). The patients treated with darbepoetin α had more advanced stages of CKD (p <0.001); those who received epoetin β plus heart failure (HF) (p = 0.002) and ischemic heart disease (p = 0.028). 54.5% of the patients reached the therapeutic objective at 3 months. Treatment with statins (OR: 0.4 (95% CI: 0.174-0.996)) and insulin (OR: 2.6 (95% CI: 1.1-5.2)) were related to achieving the therapeutic response. Baseline Hb (Hb_b) and basal Fe (Fe_b) influenced ΔHb (%) (p <0.001 and 0.007, respectively. 2.5% had an ischemic cerebrovascular accident (CVA) in the 24-month follow-up. 35.9% (n = 71) continued treatment with ESA at 24 months: 40.4% with darbepoetin α vs 24.6% with epoetin β (p = 0.001).
Conclusions: ESAs safely correct and maintain Hb levels with moderate doses of ESAs.
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