Usage of the Anemia Control Model Is Associated with Reduced Hospitalization Risk in Hemodialysis.

Autor:	Garbelli M; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Baro Salvador ME; Nephrocare Spain, Fresenius Medical Care, 08013 Barcelona, Spain., Rincon Bello A; Nephrocare Spain, Fresenius Medical Care, 08013 Barcelona, Spain., Samaniego Toro D; Nephrocare Spain, Fresenius Medical Care, 08013 Barcelona, Spain., Bellocchio F; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Fumagalli L; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Chermisi M; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Apel C; Health Economics and Market Access, Fresenius Medical Care, 61352 Bad Homburg, Germany., Petrovic J; Health Economics and Market Access, Fresenius Medical Care, 61352 Bad Homburg, Germany., Kendzia D; Health Economics and Market Access, Fresenius Medical Care, 61352 Bad Homburg, Germany., Ion Titapiccolo J; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Yeung J; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Barbieri C; Global Digital and Innovation Technology Department, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Mari F; Global Digital and Innovation Technology Department, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Usvyat L; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Larkin J; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Stuard S; Clinical and Therapeutic Governance EMEA, Medical Affairs, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy., Neri L; Clinical Advanced Analytics, Global Medical Office, Fresenius Medical Care, 26020 Vaiano Cremasco, Italy.
Jazyk:	angličtina
Zdroj:	Biomedicines [Biomedicines] 2024 Sep 28; Vol. 12 (10). Date of Electronic Publication: 2024 Sep 28.
DOI:	10.3390/biomedicines12102219
Abstrakt:	Introduction: The management of anemia in chronic kidney disease (CKD-An) presents significant challenges for nephrologists due to variable responsiveness to erythropoietin-stimulating agents (ESAs), hemoglobin (Hb) cycling, and multiple clinical factors affecting erythropoiesis. The Anemia Control Model (ACM) is a decision support system designed to personalize anemia treatment, which has shown improvements in achieving Hb targets, reducing ESA doses, and maintaining Hb stability. This study aimed to evaluate the association between ACM-guided anemia management with hospitalizations and survival in a large cohort of hemodialysis patients. Methods: This multi-center, retrospective cohort study evaluated adult hemodialysis patients within the European Fresenius Medical Care NephroCare network from 2014 to 2019. Patients treated according to ACM recommendations were compared to those from centers without ACM. Data on demographics, comorbidities, and dialysis treatment were used to compute a propensity score estimating the likelihood of receiving ACM-guided care. The primary endpoint was hospitalizations during follow-up; the secondary endpoint was survival. A 1:1 propensity score-matched design was used to minimize confounding bias. Results: A total of 20,209 eligible patients were considered (reference group: 17,101; ACM adherent group: 3108). Before matching, the mean age was 65.3 ± 14.5 years, with 59.2% men. Propensity score matching resulted in two groups of 1950 patients each. Matched ACM adherent and non-ACM patients showed negligible differences in baseline characteristics. Hospitalization rates were lower in the ACM group both before matching (71.3 vs. 82.6 per 100 person-years, p < 0.001) and after matching (74.3 vs. 86.7 per 100 person-years, p < 0.001). During follow-up, 385 patients died, showing no significant survival benefit for ACM-guided care (hazard ratio = 0.93; p = 0.51). Conclusions: ACM-guided anemia management was associated with a significant reduction in hospitalization risk among hemodialysis patients. These results further support the utility of ACM as a decision-support tool enhancing anemia management in clinical practice.
Databáze:	MEDLINE
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