Outcomes in patients with chronic kidney disease not on dialysis receiving extended dosing regimens of darbepoetin alfa: long-term results of the EXTEND observational cohort study
| Autor: | István Kiss, Janet Addison, Alain P. Guerin, Michael Suranyi, Mourad Farouk, Jan-Christoph Galle, Nick Manamley, Gerhard Wirnsberger, Salvatore Di Giulio, Christopher G. Winearls, Hans Herlitz, Kathleen Claes |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Darbepoetin alfa medicine.drug_class Anemia medicine.medical_treatment 030232 urology & nephrology 030204 cardiovascular system & hematology CLINICAL SCIENCE Cohort Studies 03 medical and health sciences 0302 clinical medicine Renal Dialysis hemic and lymphatic diseases Internal medicine Chronic Kidney Disease medicine Humans Dosing Renal Insufficiency Chronic Intensive care medicine Dialysis Aged Aged 80 and over anaemia Transplantation erythropoiesis-stimulating agent business.industry Middle Aged Erythropoiesis-stimulating agent medicine.disease Kidney Transplantation extended dosing Treatment Outcome Nephrology Hematinics Female Hemodialysis business Kidney disease medicine.drug |
| Zdroj: | Nephrology Dialysis Transplantation |
| Popis: | Background Extended dosing of the erythropoiesis-stimulating agent (ESA) darbepoetin alfa (DA) once biweekly or monthly reduces anaemia treatment burden. This observational study assessed outcomes and dosing patterns in patients with chronic kidney disease not on dialysis (CKD-NoD) commencing extended dosing of DA. Methods Adult CKD-NoD patients starting extended dosing of DA in Europe or Australia in June 2006 or later were followed up until December 2012. Outcomes included haemoglobin (Hb) concentration, ESA dosing, mortality rates and receipt of dialysis and renal transplantation. Subgroup analyses were conducted for selected outcomes. Results Of 6035 enrolled subjects, 5723 (94.8%) met analysis criteria; 1795 (29.7%) received dialysis and 238 (3.9%) underwent renal transplantation. Mean (standard deviation) Hb concentration at commencement of extended dosing was 11.0 (1.5) g/dL. Mean [95% confidence interval (CI)] Hb 12 months after commencement of extended dosing (primary outcome) was 11.6 g/dL (11.5, 11.6) overall and was similar across countries, with no differences between subjects previously treated with an ESA versus ESA-naive subjects, subjects with versus without prior renal transplant or diabetics versus non-diabetics. Weekly ESA dose gradually decreased following commencement of extended DA dosing and was similar across subgroups. The decrease in weekly DA dose was accompanied by an increase in the proportion of patients receiving iron therapy. Hb concentrations declined following changes in ESA labels and treatment guidelines. The mortality rate (95% CI) was 7.06 (6.68, 7.46) deaths per 100 years of follow-up. Subjects alive at study end had stable Hb concentrations in the preceding year, while those who died had lower and declining Hb concentrations in their last year. Conclusions Long-term, extended dosing of DA maintained Hb concentrations in patients already treated with an ESA and corrected and maintained Hb in ESA-naive patients. |
| Databáze: | OpenAIRE |
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