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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Kidney+Dis
2014 ; 64
(5
): 706-13
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Erythropoiesis-stimulating agent use among non-dialysis-dependent CKD patients
before and after the trial to Reduce Cardiovascular Events With Aranesp Therapy
(TREAT) using a large US health plan database
#MMPMID25011692
Thamer M
; Zhang Y
; Kshirsagar O
; Cotter DJ
; Kaufman JS
Am J Kidney Dis
2014[Nov]; 64
(5
): 706-13
PMID25011692
show ga
BACKGROUND: In a landmark study, TREAT (Trial to Reduce Cardiovascular Events
With Aranesp Therapy) examined the use of erythropoiesis-stimulating agent (ESA)
therapy to treat anemia among patients with chronic kidney disease (CKD) and
found no benefit compared to placebo. STUDY DESIGN: A retrospective observational
design was used to determine the impact of TREAT on clinical practice. SETTING &
PARTICIPANTS: A large US health plan database with more than 1.2 million claims
for patients with non-dialysis-dependent CKD stages 3 and 4. FACTOR: ESA
prescribing 2 years before and after publication of TREAT. OUTCOMES: Rate of ESA
prescribing for ESA-naive and -prevalent cohorts. MEASUREMENTS: (1) Monthly ESA
prescribing in the 2 years before and after publication of TREAT (ordinary least
squares regression), (2) adjusted likelihood of prescribing ESA after TREAT
(clustered logistic regression), and (3) probability of receiving ESA therapy
based on anemia status (?(2) test). RESULTS: For patients with CKD stage 3, the
proportion prescribed ESA therapy declined from 17% pre-TREAT to 11% post-TREAT
(a 38% decline), and for those with CKD stage 4, from 34% to 27% (a 22% decline).
Prescribing of ESA therapy was declining even before TREAT, but the decline
accelerated in the post-TREAT period (stage 3: change of slope, -0.08 [P<0.001];
stage 4: change of slope, -0.16 [P<0.001]). ESA prescribing declined after TREAT
regardless of anemia status; among patients with hemoglobin levels <10g/dL, only
25% of patients with CKD stage 3 and 33% of patients with stage 4 were prescribed
ESAs 2 years after TREAT, a notable 50% decline. After adjusting for all
covariates, the probability of prescribing ESAs was 35% lower during the 2-year
period after versus before publication of TREAT (OR, 0.65; 95% CI, 0.63-0.67).
LIMITATIONS: The cumulative effect of adverse safety concerns in the period
before TREAT also influenced physician prescribing of ESA therapy and could not
be separated from the influence of TREAT. CONCLUSIONS: TREAT appears to be a
watershed study that was followed by a marked decline in ESA prescribing for
patients with CKD.
|*Renal Dialysis
[MESH]
|Aged
[MESH]
|Cardiovascular Diseases/*chemically induced/epidemiology/*prevention & control
[MESH]