Anemia in peritoneal dialysis patients: a cohort study of Dialysis Tuscany Registry

Abstract

Introduction: The optimization of anaemia treatment in dialysis patients is a main concern worldwide considering its health and financial implications. The use of erythropoiesis-stimulating agents (ESAs) usually allows good control of hemoglobin levels both in hemodialysis (HD) and in peritoneal dialysis (PD) patients. Although RCT are available only for HD and PD patients, strong evidences lack. Our aim was to evaluate anaemia management in HD and PD patients treated in Tuscany. Methods: We analyzed data of 2440 patients registered by the Tuscany Registry of Dialysis and Transplantation (RTDT) and by the Tuscany Group of Peritoneal Dialysis in order to evaluate the differences in terms of anaemia correction, ESAs employment and iron status between HD and PD patients. Results: PD patients showed higher and stable mean levels of Hb over the last 10 years whereas mean Hb levels in HD patient tended to lower in the last years according to guidelines suggestions. In PD patients resistance to erythropoietin therapy was lower and patients reached higher levels of Hb (11.6 ± 1.3 vs 11.3 ± 2.4 p = 0.02) receiving a lesser weekly dose of ESAs (8000 vs 6000 UI p = 0.002). A lower percentage of patients received iron supplementation in PD (67.2 vs 33.1% p<0.01) with significantly inferior levels of ferritin but similar levels of TSAT. In PD patients the percentage of long acting ESAs was higher, the erythropoietin resistance index was lower and long acting ESAs are preferred. According to cost-effectiveness analyses the weekly cost of anaemia management is 14% lower in PD patients. Conclusions: PD patients had a better correction with lower dosage of ESAs, lower iron supplementation and better cost-effectiveness ratio.