Comparison of Patient Survival According to Erythropoiesis-Stimulating Agent Type of Treatment in Maintenance Hemodialysis Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population and Variables
2.3. Statistical Analyses
3. Results
3.1. Participant Clinical Characteristics
3.2. Survival Analyses
3.3. Subgroup Analyses
3.4. Factors Associated with ERI
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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EP (n = 38,043) | DP (n = 10,054) | MR (n = 2253) | p | |
---|---|---|---|---|
Age (years) | 60.8 ± 13.0 | 61.4 ± 13.1 * | 62.1 ± 12.6 *,† | <0.001 |
Sex (male, %) | 22,544 (59.3%) | 5683 (56.5%) | 1325 (58.8%) | <0.001 |
Hemodialysis vintage (days) | 1468 ± 1618 | 1383 ± 1530 * | 1380 ± 1548 * | <0.001 |
CCI score | 7.7 ± 2.9 | 7.7 ± 2.8 | 8.1 ± 2.9 *,† | <0.001 |
Body mass index (kg/m2) | 22.4 ± 3.5 | 22.5 ± 3.5 * | 22.8 ± 3.4 *,† | <0.001 |
Underlying etiology of ESRD | <0.001 | |||
Diabetes mellitus | 17,031 (44.8%) | 4681 (46.6%) | 1068 (47.4%) | |
Hypertension | 10,069 (26.5%) | 2474 (24.6%) | 577 (25.6%) | |
Glomerulonephritis | 3846 (10.1%) | 1058 (10.5%) | 220 (9.8%) | |
Other | 2951 (7.8%) | 976 (9.7%) | 175 (7.8%) | |
Unknown | 4146 (10.9%) | 865 (8.6%) | 213 (9.5%) | |
Follow-up duration (days) | 1814 ± 847 | 1763 ± 838 * | 1826 ± 830 † | <0.001 |
Type of vascular access | <0.001 | |||
Arteriovenous fistula | 31,631 (83.1%) | 8228 (81.8%) | 1867 (82.9%) | |
Arteriovenous graft | 5502 (14.5%) | 1514 (15.1%) | 345 (15.3%) | |
Catheter | 910 (2.4%) | 312 (3.1%) | 41 (1.8%) | |
Kt/Vurea | 1.52 ± 0.27 | 1.56 ± 0.29 * | 1.56 ± 0.27 * | <0.001 |
Ultrafiltration volume (L/session) | 2.26 ± 0.95 | 2.19 ± 0.97 * | 2.16 ± 0.99 * | <0.001 |
Hemoglobin (g/dL) | 10.6 ± 0.7 | 10.7 ± 0.7 * | 10.7 ± 0.8 * | <0.001 |
Serum albumin (g/dL) | 4.00 ± 0.34 | 3.92 ± 0.35 * | 3.93 ± 0.33 * | <0.001 |
Serum phosphorus (mg/dL) | 5.0 ± 1.4 | 4.8 ± 1.3 * | 4.9 ± 1.4 † | <0.001 |
Serum calcium (mg/dL) | 8.9 ± 0.8 | 8.8 ± 0.7 * | 8.8 ± 0.8 * | <0.001 |
Serum creatinine (mg/dL) | 9.4 ± 2.7 | 9.3 ± 2.7 * | 9.0 ± 2.6 *,† | <0.001 |
Systolic blood pressure (mmHg) | 142 ± 15 | 140 ± 16 * | 143 ± 16 † | <0.001 |
Diastolic blood pressure (mmHg) | 78 ± 9 | 76 ± 10 * | 76 ± 10 * | <0.001 |
Univariate | Multivariate | |||
---|---|---|---|---|
HR (95% CI) | p | HR (95% CI) | p | |
Ref: EP group | ||||
DP group | 1.01 (0.98–1.05) | 0.527 | 1.01 (0.97–1.05) | 0.740 |
MR group | 0.97 (0.91–1.04) | 0.433 | 0.89 (0.83–0.97) | 0.006 |
Ref: DP group | ||||
MR group | 0.96 (0.89–1.04) | 0.302 | 0.89 (0.82–0.97) | 0.006 |
Age (per 1 year increase) | 1.07 (1.06–1.07) | <0.001 | 1.06 (1.06–1.07) | <0.001 |
Sex (ref: male) | 0.85 (0.83–0.88) | <0.001 | 0.75 (0.72–0.78) | <0.001 |
CCI score (per 1 score increase) | 1.14 (1.13–1.14) | <0.001 | 1.06 (1.06–1.07) | <0.001 |
Body mass index (per 1 kg/m2 increase) | 0.97 (0.97–0.98) | <0.001 | 0.98 (0.97–0.98) | <0.001 |
Underlying etiology of ESRD (ref: DM) | ||||
Glomerulonephritis | 0.34 (0.32–0.37) | <0.001 | 0.53 (0.48–0.57) | <0.001 |
Hypertension | 0.66 (0.64–0.69) | <0.001 | 0.67 (0.64–0.70) | <0.001 |
Other | 0.53 (0.50–0.56) | <0.001 | 0.69 (0.64–0.74) | <0.001 |
Unknown | 0.60 (0.57–0.64) | <0.001 | 0.70 (0.65–0.74) | <0.001 |
Hemoglobin (per 1 g/dL increase) | 0.85 (0.83–0.87) | <0.001 | 0.94 (0.91–0.96) | <0.001 |
Serum creatinine (per 1 mg/dL increase) | 0.86 (0.86–0.87) | <0.001 | 0.94 (0.94–0.95) | <0.001 |
SBP (per 1 mmHg increase) | 1.01 (1.01–1.01) | <0.001 | 1.00 (1.00–1.01) | <0.001 |
DBP (per 1 mmHg increase) | 0.98 (0.98–0.98) | <0.001 | 1.00 (1.00–1.01) | 0.011 |
Serum calcium (per 1 mg/dL increase) | 0.94 (0.92–0.95) | <0.001 | 1.07 (1.05–1.09) | <0.001 |
Serum phosphorus (per 1 mg/dL increase) | 0.84 (0.83–0.85) | <0.001 | 1.04 (1.03–1.06) | <0.001 |
Kt/Vurea (per 1 unit increase) | 0.91 (0.86–0.97) | 0.002 | 0.74 (0.68–0.80) | <0.001 |
Serum albumin (per 1 g/dL increase) | 0.36 (0.35–0.38) | <0.001 | 0.63 (0.60–0.67) | <0.001 |
HD vintage (per 1 day increase) | 1.00 (1.00–1.00) | 0.004 | 1.00 (1.00–1.00) | <0.001 |
Ultrafiltration volume (per 1 L increase) | 0.92 (0.90–0.93) | <0.001 | 1.06 (1.04–1.08) | <0.001 |
ERI (per 1 unit increase) | 1.02 (1.02–1.02) | <0.001 | 1.03 (1.02–1.04) | <0.001 |
ESA dose (per 1 unit/week increase) | 1.00 (1.00–1.00) | <0.001 | 1.00 (1.00–1.00) | <0.001 |
Limitations | |
---|---|
Design | Retrospective observational design |
Data set | No data on iron supplementation or iron status |
No data on micronutrients | |
No data on the route of injection of ESAs | |
No data on patient inflammatory status during the treatment period | |
No data on safety issues related to ESA treatment | |
Definitions of types or doses of ESA using claims data | |
Definitions of comorbidities using claims data | |
No consideration of the factors related to the centers or physicians | |
Use of two or more ESAs in a small proportion of patients | |
Statistical analysis | Imbalance in sample size and baseline characteristics among the three groups |
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Kang, S.H.; Kim, B.Y.; Son, E.J.; Kim, G.O.; Do, J.Y. Comparison of Patient Survival According to Erythropoiesis-Stimulating Agent Type of Treatment in Maintenance Hemodialysis Patients. J. Clin. Med. 2023, 12, 625. https://doi.org/10.3390/jcm12020625
Kang SH, Kim BY, Son EJ, Kim GO, Do JY. Comparison of Patient Survival According to Erythropoiesis-Stimulating Agent Type of Treatment in Maintenance Hemodialysis Patients. Journal of Clinical Medicine. 2023; 12(2):625. https://doi.org/10.3390/jcm12020625
Chicago/Turabian StyleKang, Seok Hui, Bo Yeon Kim, Eun Jung Son, Gui Ok Kim, and Jun Young Do. 2023. "Comparison of Patient Survival According to Erythropoiesis-Stimulating Agent Type of Treatment in Maintenance Hemodialysis Patients" Journal of Clinical Medicine 12, no. 2: 625. https://doi.org/10.3390/jcm12020625