Increased mortality in haemodialysis patients administered high doses of erythropoiesis-stimulating agents: a propensity score-matched analysis
| Autor: | Pérez-García, Rafael, Varas, Javier, Cives, Alejandro, Martín-Malo, Alejandro, Aljama, Pedro, Ramos, Rosa, Pascual, Julio, Stuard, Stefano, Canaud, Bernard, Merello, José Ignacio, ORD group |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty 030232 urology & nephrology 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Renal Dialysis hemic and lymphatic diseases Internal medicine medicine Risk of mortality Humans Mortality Renal Insufficiency Chronic Propensity Score Survival rate Survival analysis Aged Retrospective Studies Transplantation Proportional hazards model business.industry Retrospective cohort study Prognosis medicine.disease Hospitalization Survival Rate Nephrology Propensity score matching Cohort Hematinics Female business Kidney disease |
| Zdroj: | Nephrology Dialysis Transplantation. 33:690-699 |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gfx269 |
| Popis: | Background Erythropoiesis-stimulating agents (ESAs) are widely used to treat anaemia in patients with chronic kidney disease. The issue of ESA safety has been raised in multiple studies, with correlates derived for elevated cancer incidence and mortality. Whether these associations are related to ESA dose or the typology of the patient remains obscure. Methods A multicentre, observational retrospective propensity score-matched study was designed to analyse the effects of weekly ESA dose in 1679 incident haemodialysis (HD) patients. ESA administration was according to standard medical practice. Patients were grouped as quintiles, according to ESA dose, in order to compare mortality and hospitalization data. Using propensity score matching (PSM), we defined two groups of 324 patients receiving weekly threshold ESA doses of either > or ≤8000 IU. Results Kaplan-Meier survival curves indicated significant increases in the risk of mortality in patients administered with high doses of ESAs (>8127.4 IU/week). Multivariate Cox models identified a high ESA dose as an independent predictor for all-cause and cardiovascular (CV) mortality. Moreover, logistic regression models identified high ESA doses as an independent predictor for all-cause, CV and infectious hospitalization. PSM analyses confirmed that weekly ESA doses of >8000 IU constitute an independent predictor of all-cause mortality and hospitalization, even though the adjusted cohort displayed the same demographic features, inflammatory profile, clinical HD parameters and haemoglobin levels. Conclusions Our data suggest that ESA doses of >8000 IU/week are associated with an increased risk of all-cause mortality and hospitalization in HD patients. |
| Databáze: | OpenAIRE |
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