Factors precipitating erythropoiesis-stimulating agent responsiveness in a European haemodialysis cohort: case-crossover study

Détails

ID Serval
serval:BIB_32E33B520DED
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Factors precipitating erythropoiesis-stimulating agent responsiveness in a European haemodialysis cohort: case-crossover study
Périodique
Pharmacoepidemiol Drug Saf
Auteur⸱e⸱s
Gillespie I. A., Macdougall I. C., Richards S., Jones V., Marcelli D., Froissart M., Eckardt K. U.
Collaborateur⸱rice⸱s
Committee A. R. O. Steering
ISSN
1099-1557 (Electronic))
ISSN-L
1053-8569
Statut éditorial
Publié
Date de publication
2015
Volume
24
Numéro
4
Pages
414-26
Langue
anglais
Notes
Gillespie, Iain A
Macdougall, Iain C
Richards, Sharon
Jones, Vincent
Marcelli, Daniele
Froissart, Marc
Eckardt, Kai-Uwe
eng
Research Support, Non-U.S. Gov't
England
2015/02/19 06:00
Pharmacoepidemiol Drug Saf. 2015 Apr;24(4):414-26. doi: 10.1002/pds.3755. Epub 2015 Feb 17.
Résumé
PURPOSE: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is clinically and economically important in the treatment of anaemia in chronic kidney disease (CKD) patients. Previous studies focused on baseline predictors of ESA hyporesponsiveness, rather than factors associated with the transition to this state. Reversibility of ESA hyporesponsiveness has also not been studied previously. METHODS: Case-crossover methodology was applied to a cohort of 6645 European CKD patients undergoing haemodialysis and prescribed ESAs. Ninety-day ESA exposure periods were defined, haemoglobin (Hb) response was calculated using the last 30 days of one period and the first 30 days of the next, and periods were classified based on a median ESA dose (80.8 IU/kg/week) and a 10 g/dL Hb threshold. Clinical, dialysis and laboratory data from patients' first hyporesponsive 'case' period was compared with the preceding responsive 'control' period using conditional logistic regression. A similar approach was applied to hyporesponsiveness reversal. RESULTS: Of the patients, 672 experienced hyporesponsiveness periods with preceding responsive periods; 711 reversed to normality from hyporesponsiveness periods. Transition to hyporesponsiveness was associated with hospitalization, vascular access changes or worsening inflammation, with these factors accounting for over two-thirds of transitions. Findings were largely insensitive to alternative ESA doses and Hb thresholds. Continued hospitalization, catheter insertion and uncontrolled secondary hyperparathyroidism were associated with a lack of regain of responsiveness. CONCLUSIONS: Transition to hyporesponsiveness is linked to the development of conditions such as hospitalization events, vascular access issues or episodes of systemic inflammation. However, a third of hyporesponsive episodes remain unexplained.
Mots-clé
Anemia/*drug therapy, Cohort Studies, Cross-Over Studies, Dose-Response Relationship, Drug, Europe, Hematinics/*therapeutic use, Humans, Logistic Models, Multivariate Analysis, *Renal Dialysis, Risk Factors, Ckd, anaemia, erythropoietin, haemodialysis, hyporesponsiveness, pharmacoepidemiology
Pubmed
Open Access
Oui
Création de la notice
03/03/2016 16:49
Dernière modification de la notice
21/08/2019 5:35
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