Use of Erythropoiesis Stimulating Agents Has Declined Over the Past Year in the U.S. Dialysis Setting, While Oral Iron Use in Dialysis Has Increased

At Last Measure, Hemoglobin Levels in Dialysis Patients Have Declined, According to a New Report from BioTrends Research Group

Jun 20, 2013, 09:00 ET from BioTrends Research Group

EXTON, Penn., June 20, 2013 /PRNewswire/ -- BioTrends Research Group, one of the world's leading research and advisory firms for specialized biopharmaceutical issues, finds that the use of erythropoiesis stimulating agents (ESAs) in the U.S. has declined in the dialysis setting over the past year.


The ChartTrends: Renal Anemia in Dialysis (U.S.) 2013 report, the third ChartTrends dialysis report that has published since the dialysis bundle legislation was implemented in January 2011, finds that physicians are initiating ESAs at lower hemoglobin levels compared to last year, but this did not reach statistical significance (p=0.058).

The report also captures the mean hemoglobin at last measure for dialysis patients, which declined significantly from 2012. In 2013, overall mean hemoglobin levels at last measure are similar regardless of where patients receive dialysis. However, the percentage of patients with hemoglobin less than 10 g/dL is highest in the small / medium dialysis organization and the non-chain hospital settings, and is significantly higher compared with the large dialysis organization setting.

The report also finds that use of oral iron in dialysis increased significantly from 2012, yet the use of IV iron remained statistically flat. In hemodialysis, nephrologists accurately assessed their use of ESAs, IV iron and oral iron with no statistical differences between reported and audited use.

In the IV iron market, Fresenius' Venofer continues to lead in hemodialysis patient share, followed by Sanofi's Ferrlecit in a distant second. Other iron products, such as iron dextran and AMAG Pharmaceutical's Feraheme capture a significantly higher share in patients dialyzed in the small / medium dialysis organization and the non-chain hospital settings compared with the large dialysis organization setting.

"The decline in the use of ESAs and lower mean hemoglobin levels, coupled with increase in blood transfusions is a concerning phenomenon for U.S. dialysis patients," said BioTrends Director Rob Dubman. "We question whether the Quality Incentive Program that went into effect on January 1, 2012, removing the weighted parameter for the percentage of patients with hemoglobin less than 10 grams per deciliter, may be causing some of the changes found in the audit this year. Also, the increase in the use of oral iron in dialysis may be due to clinics reducing cost by using more inexpensive therapies."

ChartTrends: Renal Anemia in Dialysis (U.S.) 2013 is a syndicated report series, in which 242 U.S. nephrologists provided patient chart data on 1,012 dialysis patients in the United States to uncover the actual management related to renal anemia. Through an in-depth review of patient charts, details such as product dosing and titration, switching, concomitant medications and a host of laboratory and patient demographic variables, help define patient types and identify therapy triggers. The study also evaluates referral patterns, co-morbidities, concomitant medications, blood transfusions, hospitalizations and a host of other patient demographics and laboratory data.

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SOURCE BioTrends Research Group