Evaluation of Inpatient Epoetin Alfa Dosing in Patients With Anemia of Chronic Kidney Disease: A Retrospective Cohort Study.

IF 3.7 4区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical therapeutics Pub Date : 2026-10-19 DOI:10.1016/j.clinthera.2026.10.001

Rita Elhamra, Timothy Streck, Tomona Iso, Lisa T Hong

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引用次数: 0

Abstract

Purpose: Epoetin alfa labeling and clinical guidelines recommend weight-based dosing for the management of patients with anemia and chronic kidney disease (CKD). However, fixed dosing continues to be used in inpatient practice, and comparative data in hospitalized populations are limited. This study aimed to compare fixed versus weight-based dosing in hospitalized patients with CKD.

Methods: This retrospective cohort study included hospitalized adult patients with anemia of CKD who were initiated on epoetin alfa at a large academic medical center between January 2014 and August 2024. The primary outcome was hemoglobin exceeding targets (>10 g/dL for non-dialysis-dependent CKD and >11 g/dL for dialysis-dependent CKD). Secondary outcomes included 90-day all-cause mortality, rehospitalization, major adverse cardiovascular events, packed red blood cell transfusion, new or worsening hypertension, and iron deficiency.

Findings: Among 100 patients (50 in the fixed-dose group and 50 in the weight-based dose group), hemoglobin exceeded targets in 8% and 4% of patients, respectively (P = 0.678). Ninety-day all-cause mortality occurred in 18% and 4% of patients, respectively (P = 0.160); no statistically significant differences were observed in other secondary outcomes. Fixed-dose regimens resulted in higher weight-normalized epoetin alfa doses than weight-based dosing (119.8 vs 67.1 units/kg; P < 0.001).

Implications: Among hospitalized patients with CKD, fixed-dose epoetin alfa was associated with substantially higher weight-normalized doses and numerically higher rates of hemoglobin exceeding targets and mortality, though differences in clinical outcomes were not statistically significant. These findings suggest that adherence to guideline-recommended weight-based dosing may minimize excessive epoetin alfa dosing. Larger prospective studies are needed to clarify optimal inpatient erythropoiesis-stimulating agent dosing.

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慢性肾病贫血患者住院患者促生成素剂量的评价：一项回顾性队列研究

目的：依生成素标签和临床指南推荐基于体重给药的贫血和慢性肾脏疾病（CKD）患者的管理。然而，固定剂量继续用于住院治疗，住院人群的比较数据有限。本研究旨在比较CKD住院患者的固定剂量和体重剂量。方法：这项回顾性队列研究纳入了2014年1月至2024年8月在一家大型学术医疗中心开始使用促生成素的慢性肾病贫血住院成年患者。主要结局是血红蛋白超过目标（非透析依赖性CKD为10 g/dL，透析依赖性CKD为11 g/dL）。次要结局包括90天全因死亡率、再住院、主要不良心血管事件、大量红细胞输血、新发或加重的高血压和缺铁。结果：100例患者中（固定剂量组50例，体重剂量组50例），血红蛋白超标率分别为8%和4% （P = 0.678）。90天全因死亡率分别为18%和4% (P = 0.160)；其他次要结局无统计学差异。固定剂量方案导致体重标准化的促生成素剂量高于基于体重的剂量（119.8单位/kg vs 67.1单位/kg； P < 0.001）。意义：在CKD住院患者中，固定剂量的促生成素与较高的体重标准化剂量、较高的血红蛋白超靶率和死亡率相关，尽管临床结果的差异无统计学意义。这些发现表明，遵循指南推荐的以体重为基础的剂量可以最大限度地减少过量的促生成素。需要更大的前瞻性研究来阐明住院患者促红细胞生成素的最佳剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.