Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Nephron. 2018;140(1):24-30. doi: 10.1159/000490202. Epub 2018 Jun 26.
Clinicians providing dialysis care have numerous erythropoiesis-stimulating agents (ESAs) available for treating anemia. We sought to provide a contemporary description of ESA types used in hemodialysis (HD) settings in nine European countries.
Our study uses Dialysis Outcomes and Practice Patterns Study phase 5 (2012-2015) data from nine European countries (Belgium, France, -Germany, Italy, Russia, Spain, Sweden, Turkey, and the United Kingdom). A total of 164 facilities and 3,281 patients contributed cross-sectional data. ESA types captured included short-acting epoetins (e.g., epoetin alfa, beta, etc., including biosimilars), darbepoetin alfa, and continuous erythropoietin receptor agonist (CERA; methoxy polyethylene glycol-epoetin beta).
We observed broad variability across countries in prescription of ESA types: prescription of epoetin alfa or epoetin beta ranged from 22% (France) to 78% (Russia), darbepoetin alfa prescription ranged from 13% (Russia) to 53% (UK), and CERA prescription ranged from <3% (Sweden) to 26% (France). Prescription of different ESA types varied substantially within some European countries from 2012-2015 but not across all countries in aggregate. Number of ESA types prescribed by a facility varied from 1, 2, 3, or 4 different ESA types in 32, 40, 21, and 8% of facilities, respectively. No differences were seen in the unadjusted distributions of achieved hemoglobin values by ESA type.
A variety of short- and long-acting ESAs are commonly used in European HD facilities to maintain hemoglobin at remarkably similar levels with each ESA type. The availability of numerous ESA options for managing anemia has allowed European providers to optimize anemia management according to the particular circumstances of each patient.
为治疗贫血，为透析患者提供了多种促红细胞生成素刺激剂（ESA）。本研究旨在为欧洲九个国家的血液透析（HD）环境中使用的 ESA 类型提供现代描述。
我们的研究使用了欧洲九个国家（比利时、法国、德国、意大利、俄罗斯、西班牙、瑞典、土耳其和英国）的透析结果和实践模式研究第五阶段（2012-2015 年）的数据。共有 164 个设施和 3281 名患者提供了横断面数据。所捕获的 ESA 类型包括短效促红细胞生成素（例如，促红细胞生成素阿尔法、贝塔等，包括生物类似物）、达贝泊汀阿尔法和持续红细胞生成素受体激动剂（CERA；甲氧基聚乙二醇-促红细胞生成素 beta）。
我们观察到各国之间 ESA 类型的处方存在广泛差异：促红细胞生成素阿尔法或贝塔的处方比例从 22%（法国）到 78%（俄罗斯）不等，达贝泊汀阿尔法的处方比例从 13%（俄罗斯）到 53%（英国）不等，CERA 的处方比例从 <3%（瑞典）到 26%（法国）不等。2012-2015 年期间，一些欧洲国家的不同 ESA 类型的处方存在很大差异，但并非所有国家的总体情况都如此。每个设施开处方的 ESA 类型数量分别为 32%、40%、21%和 8%的设施开具 1、2、3 或 4 种不同的 ESA 类型。ESA 类型的血红蛋白值调整后分布没有差异。
在欧洲 HD 设施中，多种短效和长效 ESA 通常用于维持血红蛋白水平，每种 ESA 类型的水平相似。由于有多种 ESA 选择用于治疗贫血，欧洲医生可以根据每位患者的具体情况优化贫血管理。
