Results of the European Survey on Anaemia Management 2003 (ESAM 2003): current status of anaemia management in dialysis patients, factors affecting epoetin dosage and changes in anaemia management over the last 5 years

Abstract

The European Survey of Anaemia Management 2003 (ESAM 2003) was a 1 day randomized survey conducted to assess anaemia management in dialysis patients 4 years after the introduction of the European Best Practice Guidelines. The survey included 8100 patients from 11 European countries and Israel. Overall, haemoglobin (Hb) levels > or =11.0 g/dl, as recommended by the guidelines, were achieved in 66% of patients. Only 48% of patients had adequate iron status, with transferrin saturation values missing for 27% and functional or absolute iron deficiency reported for 17 and 9%, respectively. In order to identify factors affecting epoetin dose and Hb levels, the countries were divided into two groups based on the percentage of patients with Hb levels > or =11.0 g/dl (>70% in group 1 and 60-70% in group 2). The most probable causes for better management in group 1 were administration of higher epoetin doses and better monitoring and management of iron status. In patients with Hb <11.0 g/dl, mean epoetin-alpha/beta doses were significantly lower for subcutaneous than intravenous (i.v.) administration, whereas mean doses were similar for both routes in patients with Hb > or =11.0 g/dl. When standardized for Hb levels, the dose ratio of i.v. epoetin-alpha/beta to i.v. darbepoetin alfa was 176:1 (95% confidence interval, 166:1-189:1). Limited comparisons between the eight countries that participated in ESAM 2003 and the original ESAM revealed that many patients still have haemoglobin levels below the current recommendations despite significant improvements in management of renal anaemia over the last 5 years.

Renal Anemia: Comparing Current Eastern and Western European Management Practice (ORAMA)

“…[1,5,15,16,20] In ORAMA, Western and Eastern European patient demographics and baseline characteristics were generally similar, although some differences were apparent. Patients enrolled were slightly older in Western Europe than in Eastern Europe.…”

“…[5,14] In 2003, a cross-sectional survey of anemia management of 8,100 dialysis patients in eight European countries made a comparison with a similar assessment carried out in 1998, prior to the publication of the first European Best Practice Guidelines (EBPG). [15] The reported increase in the percentage of patients achieving the target Hb was attributed to a concurrent increase in ESA dose. However, the percentage of patients with Hb level >11 g/dL showed considerable inter-country variation, ranging from 79% in Switzerland to 37% in Poland.…”

Biosimilar epoetins and other “follow‐on” biologics: Update on the European experiences

“…The concentration of the hormone is abnormally low when related to the hemoglobin level ([Hb]) in CKD [43]. The anemia in CKD patients is often aggravated due to accompanying inflammatory processes, reduced iron availability, hemolysis, blood losses, nutritional deficiencies, and hyperparathyroidism [44]. Before rhEPO became available, about 25% of renal failure patients on dialysis needed regular RBC transfusions [45].…”

Tratamiento de la anemia con eritropoietina y hierro en Enfermedad Renal Crónica

“…A pesar de lo anterior, la anemia sigue siendo un problema de alta prevalencia en esta población. Así, por ejemplo, de acuerdo al último reporte de ESAM (European Survey on Anemia Management) sólo en un 66% de la población estudiada (8100 pacientes adultos en tratamiento dialítico provenientes de 11 países Europeos e Israel) se alcanzaron niveles de hemoglobina mayores de 11 gr/dl 8 . En nuestro país, la Rama de Nefrología de la Sociedad Chilena de Pediatría reportó que un 82,6% de pacientes en hemodiálisis (HD), un 45,1% de pacientes en DP y un 34% de pacientes en tratamiento médico de ercr presentaban niveles de hemoglobina menores de 11,5 gr/dl [9] .…”