ABSTRACT
This is a post-hoc analysis evaluating erythropoiesis stimulating agents' (ESA) related costs while using an additional ultrafilter (Estorclean PLUS) to produce ultrapure dialysis water located within the fluid pathway after the treatment with reverse osmosis and before the dialysis machine. Twenty-nine patients (19 treated with epoetin alfa and 10 with darboepoetin alfa) were included in the analysis. We showed to gain savings of 210 per patient (35 per patient each month) with epoetin alfa during the experimental period of 6 months, compared to the control period and of 545 per patient (90 per patient each month) with darboepoetin alfa. Estorclean PLUS had a cost of 600 (25 per month per each patient) and was used for 6 months. Intravenous iron therapy with sodium ferrigluconate had a cost of 0,545 /62,5 mg. In conclusion, during the experimental period with the use of Estorclean, we obtained global savings of 11 per patient per month with epoetin alfa and 30 per patient per month with darboepoetin alfa to treat anemia in dialysis patients.
Subject(s)
Anemia/economics , Hematinics/economics , Renal Dialysis/economics , Aged , Aged, 80 and over , Anemia/drug therapy , Anemia/etiology , Cost Savings , Costs and Cost Analysis , Cross-Over Studies , Darbepoetin alfa/economics , Darbepoetin alfa/therapeutic use , Distillation/instrumentation , Epoetin Alfa/economics , Epoetin Alfa/therapeutic use , Female , Ferric Compounds/economics , Ferric Compounds/therapeutic use , Filtration/instrumentation , Hematinics/therapeutic use , Hemodialysis Solutions/economics , Hemodialysis Solutions/therapeutic use , Hemoglobins/analysis , Humans , Inflammation , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/economics , Kidney Failure, Chronic/therapy , Male , Middle Aged , Renal Dialysis/adverse effects , WaterABSTRACT
BACKGROUND: The subendocardial viability ratio (SEVR), calculated by pulse wave analysis, is an index of myocardial oxygen supply and demand. Here we analyze the relation between SEVR and cardiovascular mortality in the chronic kidney disease (CKD) population of a post hoc analysis of a multicenter, prospective, randomized, nonblinded study. METHODS: We studied 212 consecutive asymptomatic outpatients receiving care at 12 nephrology clinics in south Italy. Inclusion criteria were age >18 years, 6 months of follow-up before the enrollment and stage 3-4 CKD. RESULTS: During follow-up, 34 subjects died, 29 of them for cardiovascular causes. SEVR correlated inversely with vascular calcifications (r = -0.37) and myocardial mass (r = -0.45); SEVR changed from 1.33 ± 0.24 to 1.36 ± 0.16 (p = NS; baseline and final values, respectively) in living patients, and from 1.16 ± 0.31 to 0.68 ± 0.26 in deceased patients (p < 0.001). Kaplan-Meier curves show that that a greater reduction of SEVR values during the study (third tertile) significantly predicts cardiovascular mortality (p < 0.0001). CONCLUSIONS: This post hoc analysis shows that a reduction of SEVR values impacts cardiovascular mortality in CKD patients.
