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논문분류	춘계학술대회 초록집
제목	Influence of Different Erythropoiesis-Stimulating Agents on Mortality and Renal Disease Progression among Non-Dialysis Chronic Kidney Disease Patients
저자	Ji Hye Kim
출판정보	2024; 2024(1):
키워드
초록	Objectives: Erythropoiesis-stimulating agents (ESAs) are commonly prescribed for both dialysis-independent and -dependent chronic kidney disease (CKD) patients. However, there exists debate regarding clinical outcomes, particularly mortality, associated with short- and long-acting ESAs. This study investigated the prognostic implications of ESA type in a large cohort of non-dialysis CKD patients. Methods: Utilizing the Korean National Health Insurance Service cohort database, data from 166,673 subjects treated with epoetin α, darbepoetin, or methoxy polyethylene glycol-epoetin β (MPGB) between 2002 and 2021 were collected and followed until December 31, 2022. The primary outcomes were all-cause mortality, a decline of over 40% in estimated glomerular filtration rate (eGFR), or initiation of dialysis. Results: During follow-up, patients receiving darbepoetin or MPGB exhibited a significantly lower risk of renal composite outcomes compared to those receiving epoetin α (HR 0.523, 95% CI 0.489-0.561 and HR 0.266, 95% CI 0.246-0.288, respectively). However, darbepoetin use was associated with a significantly higher risk of all-cause death (HR 1.119, 95% CI 1.053-1.190), while MPGB use showed a significantly lower risk (HR 0.928, 95% CI 0.873-0.986) compared to epoetin α. Upon excluding subjects with missing hemoglobin data, those treated with MPGB achieving optimal hemoglobin levels (10.0-10.9 g/dL) demonstrated a higher risk of all-cause death compared to those treated with epoetin α. Conclusions: Longer-acting ESA use in non-dialysis CKD patients may correlate with a reduced risk of kidney disease progression compared to short-acting ESA use. However, longer-acting ESAs may also be associated with an increased mortality rate compared to short-acting ESAs, particularly among individuals achieving optimal hemoglobin levels with MPGB.
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