Bristol Research
Evaluating darbepoetin treatment strategies for managing anaemia in haemodialysis patients:effects on all-cause mortality from a target trial emulation using electronic health record data
By Kate Birnie, Fergus John Caskey, Yoav Ben-Shlomo and 4 others.
Abstract
Purpose
Anaemia is a common complication of chronic kidney disease, often treated with erythropoiesis-stimulating agents (ESAs), but the optimal haemoglobin (Hb) target remains uncertain. Using electronic health records, we emulated a target trial comparing different Hb targets in haemodialysis patients to estimate their effects on mortality.
Methods
We used electronic health records from UK kidney centres reporting to the UK Renal Registry. Adults aged ≥18 years, receiving haemodialysis for ≥3 months, and without marked ESA resistance were eligible. Using the clone-censor-weight method, we emulated trials comparing Hb targets: (1) 105–125 versus 95–115 g/L and (2) 125–145 versus 95–115 g/L. Darbepoetin dosing followed a standardized protocol with predefined dose adjustments and a maximum dose of 150 µg/week. The outcome was all-cause mortality over 8 months.