Epoetin alfa use in patients with ESRD: an analysis of recent US prescribing patterns and hemoglobin outcomes

Am J Kidney Dis. 2005 Sep;46(3):481-8. doi: 10.1053/j.ajkd.2005.05.018.


Background: It is unknown to what degree physicians adjust erythropoietin doses to achieve hemoglobin levels (11.0 to 12.0 g/dL [110 to 120 g/L]) recommended by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) for patients with end-stage renal disease receiving hemodialysis. Our objective is to examine epoetin alfa prescribing patterns for achieving the target hemoglobin level range in this population.

Methods: Monthly hemoglobin levels and epoetin alfa doses from 2 large databases were retrospectively analyzed. One data set comprised 31,267 patients from the Fresenius Medical Care-North America (FMC-NA) database, and the other comprised 128,761 patients based on claims for Medicare services.

Results: Longitudinal evaluation of the FMC-NA data set showed that hemoglobin levels in patients administered epoetin alfa cycled in and out of the NKF-K/DOQI hemoglobin target range, and doses were decreased in 98.8% of patients with persistent hemoglobin levels greater than 12.0 g/dL (> 120 g/L). Hemoglobin levels in patients from the Medicare data set that initially were outside the target range migrated into the range with epoetin alfa dose titration. FMC-NA patients with a 3-month average hemoglobin level less than 11.0 g/dL (< 110 g/L) were administered significantly greater epoetin alfa doses than those with average hemoglobin levels greater than 12.0 g/dL (> 120 g/L; 21,838 versus 13,503 U/wk; P < 0.0001). Less than 0.4% of patients administered epoetin alfa were persistently anemic (hemoglobin < 11.0 g/dL [< 110 g/L]) and were administered persistently high doses (> 30,000 U/wk), but failed to respond with a 0.5-g/dL or greater (> or = 5-g/L) increase in hemoglobin levels.

Conclusion: In these analyses, few hemodialysis patients experienced persistent anemia while being administered high epoetin alfa doses. Physicians appeared to appropriately adjust doses to achieve hemoglobin levels recommended by the NKF-K/DOQI guidelines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia / blood
  • Anemia / drug therapy*
  • Anemia / etiology
  • Cross-Sectional Studies
  • Databases, Factual
  • Dose-Response Relationship, Drug
  • Drug Prescriptions / standards
  • Drug Prescriptions / statistics & numerical data
  • Drug Utilization / standards
  • Drug Utilization / statistics & numerical data
  • Epoetin Alfa
  • Erythropoietin / administration & dosage
  • Erythropoietin / therapeutic use*
  • Guideline Adherence
  • Hemoglobins / analysis*
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Recombinant Proteins
  • Retrospective Studies
  • Treatment Outcome
  • United States


  • Hemoglobins
  • Recombinant Proteins
  • Erythropoietin
  • Epoetin Alfa