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SAT0186 Trends and correlates of erythropoiesis-stimulating agent use among patients with lupus nephritis reaching end-stage renal disease
  1. J.A. Gόmez-Puerta1,
  2. S. Waikar2,
  3. J. Liu3,
  4. W. Winkelmayer4,
  5. K.H. Costenbader1
  1. 1Rheumatology
  2. 2Nephrology, Brigham & Women’s Hospital, Boston
  3. 3Pharmacoepidemiology Unit, Brigham and Women’s Hospital, Boston, MA
  4. 4Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States


Background Approximately 20% of lupus nephritis (LN) patients develop end-stage renal disease (ESRD) within 10 years. As LN progresses, anemia is common. Little is known, however, about utilization patterns of erythropoiesis-stimulating agents (ESA) among U.S. patients with LN initiating treatment for ESRD.

Objectives To identify sociodemographic and clinical factors associated with ESA use among incident LN ESRD patients

Methods Individuals age ≥18 with incident LN ESRD (ICD-9 code 710.0), were identified in the US Renal Data System, 1995-2008. ESA use was ascertained from the Medical Evidence Report. Year of ESRD onset, age, sex, race/ethnicity, medical insurance, employment status, residential region, clinical factors and comorbidities were considered potentially associated with ESA use in multivariable-adjusted logistic regression analyses

Results Of 14,074 individuals with incident LN ESRD, 4,690 (33.3%) patients received an ESA at ESRD onset; use increased from 1995 to 2004 and then declined. In multivariable-adjusted models, several variables were independently related to ESA use (Table). ESA users had higher serum albumin and hemoglobin levels, were more likely women, Asian, living in the Northeast and underweight. Conversely, Medicaid beneficiaries, the uninsured, unemployed, Blacks, Hispanics, and those with IV drug use and obesity had lower ESA use.

Table 1. Factors Significantly Associated with ESA use at Onset of ESRD among 14, 074 U.S. Patients with LN from 1995-2008

Conclusions Among U.S. patients with LN-associated ESRD, one third received ESAs at ESRD onset and the proportion increased substantially between 1995 and 2004. Race, type of medical insurance, region of residence, low BMI, hypertension, CAD, PVD, and higher serum levels of albumin and hemoglobin, were significantly associated with receipt of ESA therapy.

Disclosure of Interest None Declared

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