Abstract
In 1996, the National Health Insurance Administration of Taiwan applied a restrictive reimbursement criteria for erythropoiesis-stimulating agents (ESAs) use in patients with chronic kidney disease. The maximal ESAs dosage allowed by insurance is capped at 20,000 U of epoetin per month. Nephrologists avoided the use of high ESA dosages to achieve a hemoglobin level of 10–11 g/dL using iron supplementation. We assessed the association of anemia and iron parameters with mortality among peritoneal dialysis (AIM-PD) patients. A retrospective cohort study was conducted based on the Taiwan Renal Registry Data System. From January 1, 2000 to December 31, 2008, we enrolled 4356 well-nourished PD patients who were older than 20 years and had been receiving PD for more than 12 months. All patients were divided into subgroups according to different hemoglobin, ferritin and transferrin saturation (TSAT) values. Patients were followed until death or December 31, 2008. In a median 2.9-year study period, 694 (15.9%) patients died. By multivariate adjustment, a hemoglobin level lower than 10 g/dL was significantly associated with a higher risk for all-cause and cardiovascular deaths. Moreover, a serum ferritin level higher than 800 ng/mL was associated with a higher risk for all-cause deaths, and a TSAT value between 20 and 50% was associated with the lowest all-cause mortality. In conclusions, we recommend avoiding a low hemoglobin level and a serum ferritin level of more than 800 ng/mL and maintaining a TSAT value between 20 and 50%, as these conditions were associated with lower risks of all-cause mortality in the AIM-PD study.
Highlights
In 1996, the National Health Insurance Administration of Taiwan applied a restrictive reimbursement criteria for erythropoiesis-stimulating agents (ESAs) use in patients with chronic kidney disease
Using data from the Taiwan Renal Registry Data System (TWRDS)[10], we aimed to evaluate the association of Anemia and Iron parameters with Mortality among prevalent Peritoneal Dialysis patients (AIM-peritoneal dialysis (PD)) in Taiwan
All patients were divided into four groups according to hemoglobin level (< 10, 10–10.9, 11–11.9, and ≥ 12 g/dL) (Table 1), ferritin level (< 300, 300–499, 500–799, and ≥ 800 ng/mL) (Table 2) and transferrin saturation (TSAT) value (< 20, 20–29, 30–49, and ≥ 50%) (Table 3)
Summary
In 1996, the National Health Insurance Administration of Taiwan applied a restrictive reimbursement criteria for erythropoiesis-stimulating agents (ESAs) use in patients with chronic kidney disease. Thereafter, nephrologists in Taiwan avoided the use of disproportionately high dosages of ESAs to achieve a hemoglobin level of 10–11 g/ dL by increasing iron s upplementation[8,9]. The influence of these policies has been shown in HD p atients[9], but the impact in PD patients remains unknown. In the AIM-PD study, we assessed the associations of optimal hemoglobin, serum ferritin and TSAT levels with the less mortality in PD patients under the implementation of Taiwan bundled payment system for ESA use
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