Between 2005 and 2009, 15 836 ND-CKD patients were sampled. During this period, ESA use declined from 60% to 46%, and the mean dose declined from 176 to 136 µg/month; the largest decline in use and in dose occurred in 2007. Simultaneously, the mean (SD) Hb level in ESA-treated patients declined from 11.5 (1.4) to 10.6 (1.2) g/dL, though the decline was most pronounced starting in 2007. As mean Hb declined, the percent of treated patients with Hb >12 g/dL dropped from 27% to 12%, and the mean dose in this sub-population declined from 173 to 111 µg/month.

This paper examines how ESA use has decreased during the period 2005 and 2009. The authors attribute this decrease to the emergence of safety concerns and subsequent changes in product labelling, reimbursement and clinical practice guidelines. All appear to have influenced physician dosing practices leading to the decrease in the use of ESAs, lower ESA doses but also to lower achieved Hb levels in ND-CKD patients.

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