Evaluation of response to various erythropoiesis--stimulating proteins using anemia management software

European Best Practice Guidelines recommend haemoglobin (Hb) concentration >11 g/dl in patients with CKD stage 5. Hb can be increased with erythropoiesis-stimulating proteins (ESPs); however, 5-10% of patients respond poorly. The primary aim of this prospective observational study was to educate nurses to assess Hb response to ESPs and to identify potential causes of hyporesponse (blood loss, iron deficiency, infection and inflammation, inefficacious dialysis, medication, vitamin deficiency, malnutrition, secondary hyperparathyroidism, or pure red cell aplasia). The secondary aims were to follow anaemia parameters and identify the frequency and causes of hyporesponse to ESPs for 6 months. Lastly, the various ESPs used in the study population were analyzed separately.

Dialysis patients (n=402) from 18 centers in Belgium and the Grand Duchy of Luxembourg were included. Using anaemia management software (ARAMIS), nurses recorded Hb, ESP dose, and potential causes for hyporesponse every 4 weeks.

The proportion of patients treated with darbepoetin alpha, epoetin alpha, and epoetin beta was 64%, 19%, and 17%, respectively. After 6 months, 79% of patients had Hb >11 g/dl. The patient incidence of hyporesponse during the study was 14%, and a mean 9% of patients were hyporesponsive at any given time. The most common potential causes of hyporesponse were iron deficiency (being reported in 39% of hyporesponse events), medication (immunosuppressive agents, ACE inhibitors), secondary hyperparathyroidism and inflammation/malnutrition.

The ARAMIS tool served as an educational tool allowing efficient follow-up of Hb and ESP dose, and identification of potential causes of hyporesponse. Mean prevalence of hyporesponse was 9%, with iron deficiency as most commonly reported potential causative factor.