2370
EPO use in the very elderly is significantly higher than younger patients despite higher GFR and serum ferritin levels
Wendy Brown, Michelle Willicombe
Imperial College Healthcare Trust
Background. Independent of renal disease, the incidence of anaemia increases with age as reportedly hypothesised in other studies by the increased demand for Epo and the age-specific affect onred blood cell production. Observationally older patients are referred to our local low clearance clinics (LCCs) at a higher eGFR for anaemia management; however, the additional impact of aging on the clinical management of anaemia in nephrology low clearance clinics (LCC) has not been studied. Furthermore, the impact of the use of EPO on patient outcomes in the very elderlyis not known, with studies such as the TREAT trial excluding patients over the age of 75.
Aim of study. To determine the effect of increasing age on the demand of EPO use in low clearance clinics.
Methods. Analysis of prospectively collected data from 10 independent LCCs affiliated with a single renal unit was performed. Data on 1034 patients seen at least once over a one year period was analysed. Patients were divided into 4 age categories determined by overall interquartile ranges (<59, 60-72, 73-80 and over 81 years).
Results. The results are shown in the table below. Compared with the oldest group, patients in the <59 and 60-72 year age groups had a lower GFR. Despite a higher mean ferritin level in the oldest age category, patients in the lower age groups had a higher mean Hb level. A significantly higher number of patients >81 years were receiving EPO therapy compared with all other age categories.
Age group(#) / ≤59 yrs
(267) / 60-72 yrs
(265) / 73-80 yrs
(255) / ≥81 yrs*
(247)
eGFR
(Mean) / 16.8 ± 6.7 / <0.0001 / 17.6 ± 6.7 / 0.0001 / 19.4 ± 8.4 / 0.27 / 20.2 ± 8.4
Hb
(Mean) / 111.2 ± 13.9 / 0.018 / 111.7 ±
13.6 / 0.01 / 109.2 ±
12.9 / 0.50 / 108.4 ± 11.5
Ferritin
(Mean) / 223.0 ± 164.2 / 0.0001 / 248.5 ± 184.0 / 0.01 / 288.8 ± 283.4 / 0.23 / 296.9 ± 256.0
# EPO (%) / 99 (37.1) / <0.0001 / 136 (51.3) / 0.015 / 130 (51.0) / 0.013 / 154 (62.4)
#Iv Iron (%) / 93 (34.8) / 0.046 / 87 (32.8) / 0.13 / 73 (28.6) / 0.63 / 65 (26.3)
*Comparator group
On multivariate analysis, patient variables shown to be associated with EPO use include increasing age, p<0.0001; higher ferritin, p<0.0001; low GFR, p=0.01 and lower weight, p=0.0001.
Conclusion. Despite higher GFR and serum ferritin levels, EPO use in the very elderly in the LCC setting is significantly higher. Further research is needed into the mechanisms behind the increased need of EPO in this age group, together with the effect on mortality,morbidity,quality of lifeand how this impacts on frailty. This may significantly influence referral practice and future CKD guidelines.