Comparative Effectiveness of Iron and Erythropoiesis-Stimulating Agent Dosing on Health-Related Quality of Life in Patients Receiving Hemodialysis

Janet K. Freburger, Alan R. Ellis, Lily Wang, Anne M. Butler, Abhijit V. Kshirsagar, Wolfgang C. Winkelmayer, M. Alan Brookhart

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)271-282
Number of pages12
JournalAmerican Journal of Kidney Diseases
Volume67
Issue number2
DOIs
StatePublished - Feb 1 2016

Keywords

  • Health-related quality of life (HRQoL)
  • anemia
  • bolus dosing
  • chronic kidney disease (CKD)
  • dosing pattern
  • end-stage renal disease (ESRD)
  • epoetin alfa
  • erythropoiesis-stimulating agent (ESA)
  • hemodialysis (HD)
  • hemoglobin
  • intravenous iron
  • maintenance dosing
  • transferrin saturation (TSAT)

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