ESA Use in Patients with Non-Dialysis Dependent CKD

NKF Spring Clinical Meetings

Patients with non-dialysis dependent chronic kidney disease (NDD-CKD) commonly develop anemia. Since the 1980s, erythropoiesis-stimulating agents (ESAs) have been approved for the treatment of anemia related to CKD; however, use of ESAs in that patient population has been impacted by safety concerns and labeling changes following initial FDA approval.

Christine Ferro and colleagues conducted a retrospective claims analysis to examine ESA use among NDD-CKD patients using real-world data. The researchers also sought to identify predictors of ESA use in NCC-CKD patients with anemia. Results of the analysis were reported during a virtual poster session at the NKF Spring Clinical Meetings in a poster titled Predictors of ESA Use in the Non-Dialysis Dependent Chronic Kidney Disease Population with Anemia.

The analysis utilized Centers for Medicare & Medicaid Services 100% Innovator data from 2015-2018. Relevant CKD diagnosis codes were used to identify patients with NDD-CKD. From the total NDD-CKD population, two study populations were identified: ESA users and non-ESA users. Meaningful differences between the two populations were detected using chi-square analysis. Using a stepwise methodology, explanatory variables (comorbidities, markers of disease severity, and encounters with an inpatient or outpatient specialty) were selected for inclusion in a regression model to define factors predictive of ESA use.

The study sample included 1,584,851 patients with NDD-CKD. Of those, 11,335 (0.7%) used ESAs in 2018. Of those patients, 10,760 (94.9%) had an anemia diagnosis at the time of initiation of ESA therapy. Only 125,383 (8.0%) of non-ESA users had a diagnosis of anemia at any time during 2016-2018.

Results of chi-square analysis of ESA users compared with non-ESA users identified associations with variables such as hypertension (78.9% vs 11.9%), heart failure (43.0% vs 7.2%), and outpatient encounters with nephrologists (47.9% vs 3.1%).

“This study of real-world ESA treatment use among NDD-CKD patients with anemia identified predictors of ESA use that may inform those for anemia treatment,” the researchers said.

Source: Ferro C, Dieguez G, Pareja K, Szabo E, Michalopoulos E. Predictors of ESA use in the non-dialysis dependent chronic kidney disease population with anemia. Abstract of a poster presented at the National Kidney Foundation virtual Spring Clinical Meetings 2021 (Poster #170), April 9, 2021.