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Anemia. 2012; 2012: 248430.
Published online Apr 19, 2012. doi:  10.1155/2012/248430
PMCID: PMC3345210
Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study
Avani D. Joshi, 1 ,2 David A. Holdford, 2 * Donald F. Brophy, 2 Spencer E. Harpe, 2 ,3 Darcy Mays, 4 and Todd W. B. Gehr 5
1Global Heath Economics and Outcomes Research, Abbott Laboratories, North Chicago, IL 60064, USA
2Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, P.O. Box 980533, 1112 East Clay Street, Richmond, VA 23298, USA
3Department Epidemiology and Community Health, Virginia Commonwealth University School of Medicine, P.O. Box 980533, Richmond, VA 23298, USA
4Statistical Sciences & Operations Research, Virginia Commonwealth University, P.O. Box 843083, Richmond, VA 23284, USA
5VCU Internal Medicine, Division of Nephrology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA 23298, USA
*David A. Holdford: david.holdford/at/vcu.edu
Academic Editor: Aurelio Maggio
Received November 11, 2011; Accepted January 24, 2012.
Abstract
Intravenous (IV) iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in chronic kidney disease (CKD). This retrospective cohort study analyzed utilization patterns of IV iron and ESA in patients over 18 years of age admitted to University Health System Hospitals with a primary or secondary diagnosis of CKD between January 1, 2006 to December 31, 2008. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Only 8% (n = 6678) of CKD patients on ESA therapy received IV iron supplementation in university hospitals. Those receiving iron used significantly less amounts of ESAs. Patient demographics (age, race, primary payer), patient clinical conditions (admission status, severity of illness, dialysis status), and physician specialty were identified as predictors of IV iron use in CKD patients. Use of IV iron with ESAs was low despite recommendations from consensus guidelines. The low treatment rate of IV iron represents a gap in treatment practices and signals an opportunity for healthcare improvement in CKD anemic patients.
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