Vol. 35, No. 1, 2012
Issue release date: January 2012
Kidney Blood Press Res 2012;35:58–67
Original Paper
Add to my selection

Renal Anemia Treatment with ESA in Hemodialysis Patients in Relation to Early versus Late Referral in Everyday Clinical Practice in Central and Eastern European Countries: Baseline Data

Malyszko J.a · Drozdz M.b · Zolkiewicz A.c · Rutkowski B.d
aDepartment of Nephrology and Transplantology, Medical University, Bialystok, bDepartment of Nephrology, Collegium Medicum, Jagiellonian University, Cracow, cRoche Pharmaceutical Company, Warsaw, and dDepartment of Nephrology, Transplantology and Internal Diseases, Medical University, Gdansk, Poland
email Corresponding Author

 goto top of outline Key Words

  • Chronic kidney disease
  • Renal anemia
  • Hemodialysis
  • Erythropoiesis-stimulating agents
  • Central and Eastern European countries

 goto top of outline Abstract

The aim of the study was to collect retrospective data on renal anemia management, comorbidities and prospective data on 12-month standard care erythropoiesis-stimulating agent (ESA) therapy used in 398 hemodialyzed patients in selected Central and Eastern European countries (50 centers in 3 countries). Patients were divided into three groups according to ESA therapy start: group A-ESA (after start of hemodialysis, HD), B-ESA (within 3 months from start of HD), C-ESA (more than 3 months before HD). At the chronic kidney disease diagnosis, hemoglobin in all patients was 10.3 ± 2.3 g/dl; however, ferritin, iron, TSAT were within reference limits. Early ESA therapy (C) was administered to 10% of patients only. 47% of patients received ESA after start of dialysis. Before study, the mean weekly ESA dose in group C was statistically lower than in groups B and A (p < 0.001). At baseline visit, hemoglobin in group A patients was slightly lower than in group B and C patients (p = 0.025). In conclusion, in Central and Eastern European countries renal anemia therapy with ESA starts shortly before or after start of HD. This highlights important differences in standard care in Eastern Europe. However, paradoxically, due to the tight reimbursement policy we foresee the clinical implications of the TREAT trial for the chronic kidney disease population.

Copyright © 2011 S. Karger AG, Basel

 goto top of outline References
  1. National Kidney Foundation (NKF) Kidney Disease Outcome Quality Initiative (K/DOQI) Advisory Board: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis 2002;39(suppl 2):S1–S246.
  2. Eschbach JW, Adamson JW: Anaemia of end-stage renal disease (ESRD). Kidney Int 1985;28:1–5.
  3. Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE: The impact of anaemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. Am J Kidney Dis 1996;28:53–61.
  4. Portoles J, Torralbo A, Martin P, Rodrigo J, Herrero JA, Barrientos A: Cardiovascular effects of recombinant human erythropoietin in predialysis patients. Am J Kidney Dis 1997;29:541–548.
  5. Eschbach JW, Aquiling T, Haley NR, Fan MH, Blagg CR: The long-term effects of recombinant human erythropoietin on the cardiovascular system. Clin Nephrol 1992;38(suppl 1):S98–S103.

    External Resources

  6. Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, Reddan D: CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006;355:2085–2098.
  7. Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, Scherhag A, CREATE Investigators: Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071–2084.
  8. Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, Feyzi JM, Ivanovich P, Kewalramani R, Levey AS, Lewis EF, McGill JB, McMurray JJ, Parfrey P, Parving HH, Remuzzi G, Singh AK, Solomon SD, Toto R: TREAT Investigators. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009;361:2019–2032.
  9. McClellan WM, Flanders WD, Gutman RA: Variable mortality rates among dialysis treatment centres. Ann Intern Med 1992;117:332–336.
  10. Hulbert-Shearon TE, Loos E, Ashby VB, Port FK, Wolfe RA: USRDS 1999 Unit-Specific Reports for Dialysis Patients: A Summary. University of Michigan, Ann Arbor, 1999.
  11. Wiecek A, Covic A, Locatelli F, Macdougall IC, on behalf of the ORAMA Study Group: Renal anaemia: comparing current eastern and western European management practice (ORAMA). Ren Fail 2008;30:267–276.

    External Resources

  12. Rath T, Mactier RA, Weinreich T, Scherhag AW, GAIN Investigators: Effectiveness and safety of recombinant human erythropoietin beta in maintaining common haemoglobin targets in routine clinical practice in Europe: the GAIN study. Curr Med Res Opin 2009;25:961–970.
  13. European Survey on Anaemia Management (ESAM). Nephrol Dial Transplant 1999;14(suppl 5):1–76.
  14. Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.
  15. Modification of Diet in Renal Disease Study Group: Creatinine filtration, secretion and excretion during progressive renal disease. Kidney Int 1989;36:S73–S80.

    External Resources

  16. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration): A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604–612.
  17. Collins AJ, Roberts TL, St Peter WL, Chen SC, Ebben J, Constantini E: United States Renal Data System assessment of the impact of the National Kidney Foundation – Dialysis Outcomes Quality Initiative guidelines. Am J Kidney Dis 2002;39:784–795.
  18. National Kidney Foundation: NKF-K/DOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis 2006;47(suppl 3):16–85.
  19. National Kidney Foundation: NKF-KDOQI clinical practice guideline and clinical practice recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50:471–530.
  20. Valderrabano F, Horl WH, Macdougall IC, Rossert J, Rutkowski B, Wauters JP: PRE-dialysis survey on anaemia management. Nephrol Dial Transplant 2003;18:89–100.
  21. Jacobs C, Frei D, Perkins AC: Results of the European Survey on Anaemia Management 2003 (ESAM 2003): current status of anaemia management in dialysis patients, factors affecting epoetin dosage and changes in anaemia management over the last 5 years. Nephrol Dial Transplant 2005;20(suppl 3): 3–24.
  22. Valderrabano F, Horl WH, Jacobs C, et al: European best practice guidelines 1–4: evaluating anaemia and initiating treatment. Nephrol Dial Transplant 2000;15(suppl 4): 8–14.

    External Resources

  23. Pisoni RL, Bragg-Gresham JL, Young EW, et al: Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:94–111.
  24. Locatelli F, Pisoni RL, Combe C, et al: Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2004;19:121–132.
  25. Rayner HC, Pisoni RL, Bommer J, Canaud B, Hecking E, Locatelli F, Piera L, Bragg-Gresham JL, Feldman HI, Goodkin DA, Gillespie B, Wolfe RA, Held PJ, Port FK: Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2004;19:108–120.
  26. Locatelli F, Aljama P, Canaud B, et al: On behalf of the Anaemia Working Group of European Renal Best Practice (ERBP). Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp(R) Therapy (TREAT) Study. Nephrol Dial Transplant 2010;25:2846–2850.
  27. Locatelli F, Covic A, Macdougall IC, Wiecek A, on behalf of the ORAMA Study Group: ORAMA: a study to investigate EBPG impact on renal anaemia – design and baseline data. J Nephrol 2008;21:592–602.

 goto top of outline Author Contacts

Prof. Jolanta Malyszko
Department of Nephrology and Transplantology, Medical University
Zurawia 14
PL–15-540 Bialystok (Poland)
Tel. +48 85 740 9464, E-Mail jolmal@poczta.onet.pl

 goto top of outline Article Information

Received: March 3, 2011
Accepted: June 28, 2011
Published online: August 26, 2011
Number of Print Pages : 10
Number of Figures : 7, Number of Tables : 4, Number of References : 27

 goto top of outline Publication Details

Kidney and Blood Pressure Research

Vol. 35, No. 1, Year 2012 (Cover Date: January 2012)

Journal Editor: Tesar V. (Prague)
ISSN: 1420-4096 (Print), eISSN: 1423-0143 (Online)

For additional information: http://www.karger.com/KBR

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.