Trends in anemia care in older patients approaching end-stage renal disease in the United States (1995-2010).

摘要: Importance Anemia is common in patients with advanced chronic kidney disease. Whereas the treatment of anemia end-stage renal disease (ESRD) has attracted considerable attention, relatively little known about patterns and trends care received by before they start maintenance dialysis or undergo preemptive transplantation. Objective To determine Medicare beneficiaries approaching ESRD. Design, Setting, Participants Closed cohort study United States using national ESRD registry data (US Renal Data System) 67 years older who initiated underwent transplantation between 1995 2010. All eligible had uninterrupted (A+B) coverage for at least 2 Exposure Time, defined as calendar year incident Main Outcomes Measures Use erythropoiesis-stimulating agents (ESA), intravenous iron supplements, blood transfusions prior to ESRD; hemoglobin concentration time We used multivariable modified Poisson regression estimate utilization prevalence ratios (PRs). Results Records 466 803 were analyzed. The proportion receiving any ESA increased from 3.2% a peak 40.8% 2007; thereafter, use decreased modestly 35.0% 2010 (compared 1995; PR, 9.85 [95% CI, 9.04-10.74]). Among an ESA, median first recorded 120 days 337 Intravenous administration 1.2% (1995) 12.3% (2010; PR, 9.20 7.97-10.61]). monotonically 20.6% 40.3% PR, 1.88 1.82-1.95]). Mean concentrations 9.5 g/dL 1995, 10.3 2006, then moderately 9.9 Conclusions Relevance Between 2010, adults increasingly more likely be treated ESAs receive supplementation, but also transfusions.