Exploring the effect of erythropoietin on mortality using USRDS data

ABSTRACT Purpose Erythropoietin (EPO) improves measures of quality of life and reduces transfusions. Clinical trials have reported higher mortality associated with higher hemoglobin targets in varied clinical settings, making difficult the selection of erythropoiesis stimulation strategies in end‐st...

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Bibliographic Details
Published in:Pharmacoepidemiology and drug safety 2013-06, Vol.22 (6), p.593-606
Main Authors: Yang, Wei, Joffe, Marshall M., Feldman, Harold I.
Format: Article
Language:English
Subjects:
Biological and medical sciences
confounding by indication
Dose-Response Relationship, Drug
Drug therapy
Drug toxicity and drugs side effects treatment
erythropoietin
Erythropoietin - administration & dosage
Erythropoietin - adverse effects
Erythropoietin - therapeutic use
Female
Hematocrit
Hemodialysis
Humans
intention-to-treat analysis
Male
Medical Record Linkage
Medical sciences
Miscellaneous (drug allergy, mutagens, teratogens...)
Mortality
Mortality - trends
pharmacoepidemiology
Pharmacology. Drug treatments
Proportional Hazards Models
Quality of life
Renal Dialysis
Renal Insufficiency - blood
Renal Insufficiency - mortality
Renal Insufficiency - therapy
time-dependent confounding
United States
USRDS
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Summary:ABSTRACT Purpose Erythropoietin (EPO) improves measures of quality of life and reduces transfusions. Clinical trials have reported higher mortality associated with higher hemoglobin targets in varied clinical settings, making difficult the selection of erythropoiesis stimulation strategies in end‐stage kidney disease. Observational studies distinguishing an effect of EPO from underlying conditions are challenging, but promise insights relevant to real‐world settings. Methods Using data from the United States Renal Data System, we performed a retrospective cohort study of hemodialysis patients treated between 2000 and 2004. 409 364 Medicare insured patients receiving hemodialysis therapy as of January 2000 or who began dialysis after January 2000 and survived >6 months were studied. We examined the association of EPO dose in any given month with death over subsequent follow‐up. Results Within each hematocrit group (
ISSN:1053-8569
1099-1557
DOI:10.1002/pds.3452