Evaluation of the Appropriate Use of Erythropoiesis Stimulating Agents for Anaemia in Chronic Kidney Disease Patients: A Retrospective Study

Abstract

Background: Anaemia is highly prevalent in end-stage renal disease (ESRD) patients. With regards to medication for this condition, erythropoiesis-stimulating agents (ESAs) have recently become known as the standard therapeutic agent for anaemia; furthermore, ESAs are one of the costly medications that are used in specific patients by specialists. The objectives of this study were 1) to evaluate the ESAs usage pattern in chronic kidney disease (CKD) treatment including the types of ESA (Epoetin alpha and Epoetin beta), 2) assess the dosage regimen and dosage adjustment according to the recommendations in Stage 4 and Stage 5 CKD patients, as well as the efficacy and Pure Red Cell Aplasia (PRCA) adverse drug event, and 3) review the total cost of the ESA treatment and cost of inappropriate dosage adjustment. Methods: The report is a descriptive analysis, a retrospective cohort study. Patients’ data were collected from medical records or by patients’ chart reviews of Rajavithi Hospital, Bangkok, Thailand between January 2013 and April 2016. Results: A total of 390 chronic renal anaemia patients with ESAs usage were screened in the Hospital. Of this total number, 201 patients were included in the study and 189 patients were excluded due to incomplete data, had received a kidney transplant, death, or the patient had not been receiving ESAs since January 2013. The inclusion criteria were as follows: aged 18 years or older, 39 patients (19.4%) were diagnosed as Stage 4 and 162 patients (80.6%) had Stage 5 that included pre-dialysis or HD/CAPD cases. One hundred and forty-two patients (70.65%) received Epoetin alpha and 59 patients (29.35%) received Epoetin beta, respectively. In the comparison of the Epoetin alpha usage and Epoetin beta usage in order to achieve the target of a Haemoglobin concentration(Hb) between 10.0 and 12.0 g/dL, the results showed that Epoetin beta usage could significantly achieve a higher target of the Hb concentration than Epoetin alpha usage (P<0.05). In addition, the Hb concentration of the generic brand of the Epoetin alpha was more stable than the original brand of Epoetin alpha non-significantly (P->0.05). Therefore, this study showed that the total cost of ESAs treatment was about 19,077,533.97 Thai Baht (THB) and the cost of inappropriate ESAs treatment was 101,258.38 Thai Baht (THB). Furthermore, there were no adverse drug event of pure red cell aplasia (PRCA) found. Conclusion: Epoetin beta had a higher performance in terms of achieving the target of the Hb concentration in chronic renal anaemia patients. It was also found that both the original or generic name of Epoetin alpha could achieve the target of the Hb concentration for anaemia treatment. Thus, appropriate ESAs treatment could prevent value loss to all CKD patients; moreover, none of the subjects developed PRCA upon administration of the study medication.