Abstract: TH-PO966
The Setting of Administration of Erythropoiesis-Stimulating Agents Among Home Dialysis Patients in a Mid-Sized Dialysis Provider
Session Information
- Anemia in CKD: Risk Factors, Practice Patterns, Therapies
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
- Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
- Green, Gopa B., Satellite Healthcare, San Jose, California, United States
- Abra, Graham E., Satellite Healthcare, San Jose, California, United States
Background
For patients undergoing home hemodialysis (HHD) or peritoneal dialysis (PD), an erythropoiesis-stimulating agent (ESA) may be administered by healthcare professionals during clinic visits or self-administered at home. The latter option may be convenient for patients, including those with long travel time to the clinic, but may increase the risk of nonadherence. We assessed the incidence and predictors of self-administration of ESAs among home dialysis patients.
Methods
We analyzed the electronic health records of Satellite Healthcare, a mid-sized, not-for-profit dialysis provider. In 2021 and 2022, we identified all administered doses of epoetin alfa and darbepoetin alfa among home dialysis patients. For each administered dose, we identified the prescribed frequency of administration, the home dialysis modality (HHD, PD), and months since home dialysis initiation, as well as the age, sex, and race/ethnicity of the patient. We fit a logistic regression of self-administration of the ESA, using generalized estimating equations to account for intra-patient correlation.
Results
The cohort comprised 1984 patients and 54,301 ESA dose administrations. Overall, 42.0% of ESA doses were self-administered. In HHD patients, 78.1% of doses were self-administered; in PD patients, the corresponding statistic was 25.0%. Use of darbepoetin alfa, relative to epoetin alfa, was not associated with self-administration (adjusted odds ratio, 0.88; 95% CI, 0.56-1.37). Relative to once-monthly dosing, adjusted odds ratios of self-administration were 2.04 (95% CI, 1.70-2.45) with every-other-week dosing, 3.27 (2.64-4.05) with once-weekly dosing, and 4.84 (3.49-6.73) with multiple doses per week. Neither age nor sex was associated with self-administration, but relative to non-Hispanic White patients, Asian patients were less likely to self-administer ESAs (adjusted odds ratio, 0.52; 95% CI, 0.32-0.86). Each one-month increment in home dialysis duration was associated with 3% higher adjusted odds of self-administration.
Conclusion
Among contemporary home dialysis patients, self-administration of ESAs is common with HHD and uncommon with PD. Increased frequency of ESA administration and longer duration of home dialysis were associated with higher odds of self-administration, whereas Asian race was associated with lower odds.