Types of erythropoiesis-stimulating agents and risk of end-stage kidney disease and death in patients with non-dialysis chronic kidney disease
Articolo
Data di Pubblicazione:
2020
Citazione:
Types of erythropoiesis-stimulating agents and risk of end-stage kidney disease and death in patients with non-dialysis chronic kidney disease / R. Minutolo, C. Garofalo, P. Chiodini, F. Aucella, L. Del Vecchio, F. Locatelli, F. Scaglione, L. De Nicola. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 0931-0509. - (2020 Aug 23), pp. 1-8. [Epub ahead of print]
Abstract:
Background. Despite the widespread use of erythropoiesisstimulating
agents (ESAs) to treat anaemia, the risk of adverse
outcomes associated with the use of different types of ESAs in
non-dialysis chronic kidney disease (CKD) is poorly investigated.
Methods. From a pooled cohort of four observational studies,
we selected CKD patients receiving short-acting (epoetin a/b;
n¼299) or long-acting ESAs (darbepoetin and methoxy
polyethylene glycol-epoetin b; n¼403). The primary composite
endpoint was end-stage kidney disease (ESKD; dialysis or transplantation)
or all-cause death. Multivariable Cox models were
used to estimate the relative risk of the primary endpoint between
short- and long-acting ESA users.
Results. During follow-up [median 3.6 years (interquartile
range 2.1–6.3)], the primary endpoint was registered in 401
patients [166 (72%) in the short-acting ESA group and 235
(58%) in the long-acting ESA group]. In the highest tertile of
short-acting ESA dose, the adjusted risk of primary endpoint
was 2-fold higher fhazard ratio [HR] 2.07 [95% confidence interval
(CI) 1.37–3.12]g than in the lowest tertile, whereas it did
not change across tertiles of dose for long-acting ESA patients.
Furthermore, the comparison of ESA type in each tertile of ESA
dose disclosed a significant difference only in the highest tertile,
where the risk of the primary endpoint was significantly higher
in patients receiving short-acting ESAs [HR 1.56 (95% CI 1.09–
2.24); P¼0.016]. Results were confirmed when ESA dose was
analysed as continuous variable with a significant difference in
the primary endpoint between short- and long-acting ESAs for
doses >105 IU/kg/week.
Conclusions. Among non-dialysis CKD patients, the use of a
short-acting ESA may be associated with an increased risk of
ESKD or death versus long-acting ESAs when higher ESA doses
are prescribed.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
ESA; ESKD; anaemia; death; non-dialysis CKD
Elenco autori:
R. Minutolo, C. Garofalo, P. Chiodini, F. Aucella, L. Del Vecchio, F. Locatelli, F. Scaglione, L. De Nicola
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