Butler Anne M, Kshirsagar Abhijit V, Olshan Andrew F, Nielsen Matthew E, Wheeler Stephanie B, Brookhart M Alan
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
Am J Nephrol. 2015;42(3):206-15. doi: 10.1159/000440771. Epub 2015 Oct 7.
Erythropoiesis-stimulating agents (ESAs), intravenous iron, and blood transfusion are used to treat anemia in both end-stage renal disease (ESRD) and cancer. However, anemia treatment patterns have not been described among ESRD patients undergoing hemodialysis with concurrent cancer, especially in the recent era of ESA-related safety concerns.
We analyzed Medicare data from a cohort of hemodialysis patients diagnosed with incident cancer. We used multivariable generalized linear models to estimate trends and patterns in ESA use, iron use, transfusion use, epoetin alfa (EPO) dose, iron dose, and resulting hemoglobin levels (2000-2011).
Of 43,760 eligible patients, quarterly ESA use declined slightly from a peak of 94.1 to 90.0%. Quarterly EPO dose increased from 2000 to 2004, then declined; quarterly hemoglobin levels followed a similar pattern. Iron use increased rapidly from 46.9 to 79.3%. Iron dose increased until 2010 and then declined. There was an increase in the quarterly transfusion use (6.3-11.7%) and in the mean number of transfusion days per year (1.4-1.8). Anemia treatment patterns varied by demographic/clinical subgroups, especially among patients receiving chemotherapy, who required higher ESA use, EPO dose, and frequency of transfusions.
Despite safety concerns about ESAs in both the ESRD and cancer populations, the proportion of hemodialysis patients with cancer who used ESAs between 2000 and 2011 remained extremely high. EPO dose and hemoglobin levels increased and then decreased. Iron use, iron dose, and transfusions increased substantially. Future research examining the risk-benefit profile of different anemia management strategies in the dialysis population with cancer is needed.
促红细胞生成素、静脉铁剂和输血用于治疗终末期肾病（ESRD）和癌症患者的贫血。然而，对于同时患有癌症且正在接受血液透析的ESRD患者的贫血治疗模式，尚未见相关描述，尤其是在近期出现促红细胞生成素相关安全问题的时代背景下。
我们分析了来自一组确诊为新发癌症的血液透析患者的医疗保险数据。我们使用多变量广义线性模型来估计促红细胞生成素的使用趋势和模式、铁剂使用、输血使用、促红细胞生成素α（EPO）剂量、铁剂剂量以及由此产生的血红蛋白水平（2000 - 2011年）。
在43760名符合条件的患者中，促红细胞生成素的季度使用率从峰值94.1%略有下降至90.0%。EPO剂量在2000年至2004年期间增加，随后下降；季度血红蛋白水平呈现类似模式。铁剂使用率从46.9%迅速增加至79.3%。铁剂剂量在2010年之前增加，之后下降。季度输血使用率（从6.3%增至11.7%）和每年平均输血天数（从1.4天增至1.8天）均有所增加。贫血治疗模式因人口统计学/临床亚组而异，尤其是在接受化疗的患者中，他们需要更高的促红细胞生成素使用率、EPO剂量和输血频率。
尽管ESRD和癌症患者群体中都存在对促红细胞生成素安全性的担忧，但在2000年至2011年期间，患有癌症的血液透析患者使用促红细胞生成素的比例仍然极高。EPO剂量和血红蛋白水平先升高后降低。铁剂使用、铁剂剂量和输血显著增加。未来需要开展研究，以探讨在患有癌症的透析人群中不同贫血管理策略的风险效益情况。
