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- Title
Predictors of erythropoietin use in patients with cardiorenal anaemia syndrome.
- Authors
Jackevicius, Cynthia A.; Co, Mary Joana; Warner, Alberta L.
- Abstract
Objectives Chronic kidney disease ( CKD) and anemia are common in patients with heart failure ( HF) - these 3 conditions have been coined the Cardiorenal Anemia Sydrome ( CRAS). The National Kidney Foundation Kidney Disease Outcomes Quality Initiative ( NKF-K/DOQI) guidelines do not specifically address patients with CRAS, creating uncertainty in erythropoietin ( EPO) prescribing. We sought to determine predictors of EPO use in patients with CRAS. Methods We conducted a retrospective cohort study at the Veteran's Affairs Greater Los Angeles Healthcare System ( VAGLAHS), a 300+ bed facility that provides primary and tertiary inpatient, and ambulatory care services, between January 1, 2003 to December 31, 2006. A multiple logistic regression model was constructed to identify predictors of EPO use among CRAS patients. Key findings Of 2058 patients with CRAS, 213 (10.3%) were prescribed EPO. There were significant differences in baseline characteristics between the EPO and non- EPO groups. The following predictors were found to be associated with EPO prescription: iron supplementation (odds ratio [ OR] 52.70, 95% confidence interval [ CI] 11.70-237.46), renal clinic appointment ( OR 2.60, 95% CI 1.79-3.76), malignancy ( OR 1.52, 95% CI 1.07-2.16) and use of hydralazine/nitrates ( OR 1.41, 95% CI 1.03-1.92). There was an inverse association found between EPO prescription and baseline hemoglobin ( OR 0.61, 95% CI 0.53-0.70) and eGFR ( OR 0.96, 95% CI 0.94-0.97). Conclusion A small proportion of patients eligible for EPO therapy according to guidelines at the time of the study were prescribed the indicated therapy. Markers of declining renal function or those suggesting need for anemia therapy were identified as EPO predictors.
- Subjects
ANEMIA diagnosis; HEART disease diagnosis; KIDNEY disease diagnosis; CHRONIC kidney failure; CONFIDENCE intervals; ERYTHROPOIETIN; MEDICAL care; EVALUATION of medical care; MEDICAL societies; PATIENTS; PHARMACOLOGY; RESEARCH funding; LOGISTIC regression analysis; DATA analysis; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; THERAPEUTICS
- Publication
International Journal of Pharmacy Practice, 2015, Vol 23, Issue 3, p199
- ISSN
0961-7671
- Publication type
Article
- DOI
10.1111/ijpp.12133