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A Study of the Response of Elderly Patients with End-Stage Renal Disease to Epoetin Alfa or Beta

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Abstract

Background: Anaemia correction in patients with end-stage renal disease has been enhanced following the use of epoetin alfa or beta and there are a number of studies detailing its application. Dialysis centres are dealing with greater numbers of elderly patients and anaemia correction in these individuals may differ by virtue of co-existing comorbidity and their age.

Objective: The aim of this study was to examine the response of the elderly patients to anaemia correction using a locally devised anaemia correction protocol while receiving dialysis.

Methods: An incident, non-randomised, cohort observational study in a single centre was used to compare the correction of anaemia in a population of elderly (≥65 years of age) and young dialysis patients. All incident patients starting peritoneal dialysis and haemodialysis (HD) between January 1998 and December 2000 were selected and treated using a locally devised anaemia correction protocol and observed for at least 1 year. Anaemia correction following adjustments for factors such as age, comorbidity, dialysis type, dialysis access type and predialysis nephrological care was assessed.

Results: 198 patients commenced dialysis with 86 elderly patients (mean age ± SD 73.7 ± 4.9 years). The elderly patients had similar periods of predialysis nephrological care as the younger patients. Most patients received HD and required a tunnelled dialysis catheter (TC) as vascular access. Equivalent numbers of elderly patients received peritoneal dialysis. Comorbid scores were greater in the elderly and patient survival was dependent upon these comorbid factors. Following the strict use of TCs, patient survival was similar to those patients commencing HD with arterio-venous fistulae.

Anaemia correction in the elderly was similar to the younger patients, with a median haemoglobin of 11.3 g/dL. By 6 months of dialysis, most patients achieved the UK Renal Association anaemia correction standard (haemoglobin above10 g/dL). The elderly patients maintained significantly higher serum ferritin levels throughout (median 209 µg/L) and required less epoetin alfa or beta (median 91.6 units/kg/wk), indicating that functional iron deficiency in the elderly dialysis patients is less. Intravenous iron sucrose doses were similar in both age groups and iron overload (serum ferritin above 800 µg/L) had been avoided following the use of the intravenous iron protocol.

Conclusion: The study has noted that elderly patients responded to anaemia corrective therapies as well as the younger patients, despite greater levels of comorbidity while requiring less epoetin alfa or beta.

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Acknowledgements

This is a paper discussing the practical issues in managing anaemia associated with chronic renal failure in elderly patients. This is an original piece of work conducted in a single centre and no conflicts of interest exist. The results of this paper have not been partially or completely published other than in abstract form.

I would like to thank all my colleagues and staff in the Renal Unit in New Cross Hospital, Wolverhampton, UK for all the support in collating information for this paper over the years. Additional thanks to Dr D. Leung whose comments and assistance were greatly appreciated in preparing this paper.

The authors have provided no information on sources of funding directly relevant to the content of this study.

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  1. Renal Dialysis Unit, New Cross Hospital, Wolverhampton Road, Wolverhampton, WV10 OQP, UK

    Johann C. B. Nicholas

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  1. Johann C. B. Nicholas
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Correspondence to Johann C. B. Nicholas.

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Nicholas, J.C.B. A Study of the Response of Elderly Patients with End-Stage Renal Disease to Epoetin Alfa or Beta. Drugs Aging 21, 187–201 (2004). https://doi.org/10.2165/00002512-200421030-00004

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