Initiation of erythropoiesis-stimulating agents and outcomes: a nationwide observational cohort study in anaemic chronic kidney disease patients.

摘要: Background In 2012, new clinical guidelines were introduced for use of erythropoiesis-stimulating agents (ESA) in chronic kidney disease (CKD) patients, recommending lower haemoglobin (Hb) target levels and thresholds ESA initiation. These changes resulted blood these patients. However, there is limited evidence on just when should be initiated the safety a low Hb initiation policy. Methods this observational inception cohort study, Swedish, nephology-referred, ESA-naive CKD patients (n = 6348) enrolled their dropped below 12.0 g/L, they followed mortality cardiovascular events. Four different treatments evaluated applying dynamic marginal structural models: (i) begin immediately, (ii) <11.0 g/dL, (iii) <10.0 g/dL (iv) never comparison with 'current practice' [the observed (factual) survival entire study cohort]. The adjusted 3-year following begun over range (from <9.0 to g/dL) was evaluated, after adjustment covariates at baseline during follow-up. Results Overall, 36% treated ESA. Mortality follow-up 33.4% ESA-treated 27.9% non-treated subjects. associated improved subjects initial 11 then decreased again those above 11.5 g/dL. Initiating compared [hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.79-0.89 0.90; CI 0.86-0.94, respectively] did not increase risk event (HR 0.93; 0.87-1.00). Conclusion non-dialysis CKD, < 10.0-11.0 otherwise according guidelines.