TY - JOUR
T1 - Comparative Effectiveness of Iron and Erythropoiesis-Stimulating Agent Dosing on Health-Related Quality of Life in Patients Receiving Hemodialysis
AU - Freburger, Janet K.
AU - Ellis, Alan R.
AU - Wang, Lily
AU - Butler, Anne M.
AU - Kshirsagar, Abhijit V.
AU - Winkelmayer, Wolfgang C.
AU - Brookhart, M. Alan
N1 - Funding Information:
Support: This study was funded under contract no. HHSA29020050040I, Task#5 from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services (HHS), as part of the Developing Evidence to Inform Decisions About Effectiveness (DEcIDE) program. Dr Winkelmayer was also supported by National Institute of Diabetes and Digestive and Kidney Diseases grant R01DK090181 . The authors of this manuscript are responsible for its contents. Statements in the manuscript should not be construed as an endorsement by AHRQ or the HHS.
Publisher Copyright:
© 2016 National Kidney Foundation, Inc.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background The potential effects of iron-dosing strategies and erythropoiesis-stimulating agents (ESAs) on health-related quality of life (HRQoL) in the dialysis population are unclear. We examined the independent associations of bolus versus maintenance iron dosing and high versus low ESA dosing on HRQoL. Study Design Retrospective cohort design. Setting & Participants Clinical data (2008-2010) from a large dialysis organization merged with data from the US Renal Data System. 13,039 patients receiving center-based hemodialysis were included. Predictor Iron and ESA dosing were assessed during 1-month (n = 14,901) and 2-week (n = 15,296) exposure periods. Outcomes HRQoL was measured by the Kidney Disease Quality of Life (KDQOL) instrument (0-100 scale) during a 3-month follow-up period. Measurements Generalized linear mixed models, adjusting for several covariates, were used to estimate associations between iron and ESA dosing and HRQoL overall and for clinically relevant subgroups. Results For the 1-month exposure period, patients with lower baseline hemoglobin levels who received higher ESA dosing had higher physical health and kidney disease symptom scores (by 2.4 [95% CI, 0.6-4.2] and 5.6 [95% CI, 2.8-8.4] points, respectively) in follow-up than patients who received lower ESA dosing. For the 2-week exposure period, patients with low baseline hemoglobin levels who received bolus dosing had higher mental health scores (by 1.9 [95% CI, 0.0-3.8] points) in follow-up. Within the low-baseline-hemoglobin subgroup, individuals with a catheter or dialysis vintage less than 1 year who received higher ESA dosing had higher HRQoL scores in follow-up (by 5.0-9.9 points) and individuals with low baseline transferrin saturations who received bolus dosing had higher HRQoL scores in follow-up (by 2.6-5.8 points). Limitations Observational design; short duration of observation. Conclusions For individuals with low baseline hemoglobin levels, higher ESA dosing and bolus iron dosing were associated with slightly higher HRQoL scores in follow-up. These differences became more pronounced and clinically relevant for specific subgroups.
AB - Background The potential effects of iron-dosing strategies and erythropoiesis-stimulating agents (ESAs) on health-related quality of life (HRQoL) in the dialysis population are unclear. We examined the independent associations of bolus versus maintenance iron dosing and high versus low ESA dosing on HRQoL. Study Design Retrospective cohort design. Setting & Participants Clinical data (2008-2010) from a large dialysis organization merged with data from the US Renal Data System. 13,039 patients receiving center-based hemodialysis were included. Predictor Iron and ESA dosing were assessed during 1-month (n = 14,901) and 2-week (n = 15,296) exposure periods. Outcomes HRQoL was measured by the Kidney Disease Quality of Life (KDQOL) instrument (0-100 scale) during a 3-month follow-up period. Measurements Generalized linear mixed models, adjusting for several covariates, were used to estimate associations between iron and ESA dosing and HRQoL overall and for clinically relevant subgroups. Results For the 1-month exposure period, patients with lower baseline hemoglobin levels who received higher ESA dosing had higher physical health and kidney disease symptom scores (by 2.4 [95% CI, 0.6-4.2] and 5.6 [95% CI, 2.8-8.4] points, respectively) in follow-up than patients who received lower ESA dosing. For the 2-week exposure period, patients with low baseline hemoglobin levels who received bolus dosing had higher mental health scores (by 1.9 [95% CI, 0.0-3.8] points) in follow-up. Within the low-baseline-hemoglobin subgroup, individuals with a catheter or dialysis vintage less than 1 year who received higher ESA dosing had higher HRQoL scores in follow-up (by 5.0-9.9 points) and individuals with low baseline transferrin saturations who received bolus dosing had higher HRQoL scores in follow-up (by 2.6-5.8 points). Limitations Observational design; short duration of observation. Conclusions For individuals with low baseline hemoglobin levels, higher ESA dosing and bolus iron dosing were associated with slightly higher HRQoL scores in follow-up. These differences became more pronounced and clinically relevant for specific subgroups.
KW - Health-related quality of life (HRQoL)
KW - anemia
KW - bolus dosing
KW - chronic kidney disease (CKD)
KW - dosing pattern
KW - end-stage renal disease (ESRD)
KW - epoetin alfa
KW - erythropoiesis-stimulating agent (ESA)
KW - hemodialysis (HD)
KW - hemoglobin
KW - intravenous iron
KW - maintenance dosing
KW - transferrin saturation (TSAT)
UR - http://www.scopus.com/inward/record.url?scp=84951007136&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2015.09.011
DO - 10.1053/j.ajkd.2015.09.011
M3 - Article
C2 - 26508682
AN - SCOPUS:84951007136
SN - 0272-6386
VL - 67
SP - 271
EP - 282
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -