Types of Erythropoietin-Stimulating Agents and Mortality among Patients Undergoing Hemodialysis

Despite the widespread use of erythropoietin-stimulating agents (ESAs) to treat anemia in patients undergoing hemodialysis, the relative mortality risks associated with use of different types of ESAs are unknown. To compare the mortality risk associated with use of short-acting ESAs versus long-acti...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2019-06, Vol.30 (6), p.1037-1048
Main Authors: Sakaguchi, Yusuke, Hamano, Takayuki, Wada, Atsushi, Masakane, Ikuto
Format: Article
Language:English
Subjects:
Aged
Anemia - drug therapy
Anemia - etiology
Cause of Death
Clinical Epidemiology
Cohort Studies
Darbepoetin alfa - adverse effects
Darbepoetin alfa - therapeutic use
Dose-Response Relationship, Drug
Drug Administration Schedule
Epoetin Alfa - adverse effects
Epoetin Alfa - therapeutic use
Female
Humans
Japan
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - therapy
Male
Middle Aged
Multivariate Analysis
Prognosis
Proportional Hazards Models
Registries
Renal Dialysis - adverse effects
Renal Dialysis - methods
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome
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Summary:Despite the widespread use of erythropoietin-stimulating agents (ESAs) to treat anemia in patients undergoing hemodialysis, the relative mortality risks associated with use of different types of ESAs are unknown. To compare the mortality risk associated with use of short-acting ESAs versus long-acting ESAs, we conducted a nationwide cohort study of 194,698 hemodialysis patients in Japan who received either a short-acting (epoetin / or epoetin ) or a long-acting (darbepoetin or epoetin β pegol) ESA. Study outcomes were 2-year all-cause and cause-specific mortality. In addition to Cox proportional hazards models, we performed an instrumental variable analysis in which facility-level long-acting ESA prescription rates were taken as the instrumental variable. During the 2-year follow-up period, 31,557 deaths occurred. In a multivariable Cox model, long-acting ESA users had a 13% higher rate of deaths compared with short-acting ESA users, a significant difference (
ISSN:1046-6673
1533-3450
DOI:10.1681/asn.2018101007