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.
8 affiliations
- 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- 2Renal Unit, Southmead Hospital, Bristol, UK.
- 3The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
- 4Department of Noncommunicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
- 5Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK.
- 6UK Renal Registry, Bristol, UK.
- 7Boston University, School of Public Health, Boston, Massachusetts, USA.
- 8NIHR Bristol Biomedical Research Centre, Bristol, UK.
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 standardised protocol with predefined dose adjustments and a maximum dose of 150 μg/week. The outcome was all-cause mortality over 8 months.Results
The study included 8628 patients from 10 centres between 2004 and 2016; 62% male, median age 66 years (IQR 52-76). At baseline, mean Hb was 97.7 g/L (SD 15.1), and 79% of patients were receiving darbepoetin. The hazard ratio for mortality was 0.92 (95% CI 0.75-1.12) for the 105-125 versus 95-115 g/L comparison, and 1.20 (95% CI 0.94-1.54) for the 125-145 versus 95-115 g/L comparison. Adherence to the highest Hb target was lower, limiting precision.Conclusions
Targeting an Hb range of 105-125 g/L under controlled ESA dosing was not associated with increased mortality compared with 95-115 g/L. Targeting Hb levels above 125 g/L may increase mortality risk, consistent with previous trial findings.
Related
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BibTeX
@article{birnie2026evaluating,
title = {{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.}},
author = {Kate Birnie and Fergus J Caskey and Yoav Ben-Shlomo and Dorothea Nitsch and Anna Casula and Eleanor J Murray and Jonathan A C Sterne},
journal = {Pharmacoepidemiology and drug safety},
year = {2026},
month = oct,
doi = {10.1002/pds.70507},
url = {https://europepmc.org/article/MED/42893801},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Kate Birnie
AU - Fergus J Caskey
AU - Yoav Ben-Shlomo
AU - Dorothea Nitsch
AU - Anna Casula
AU - Eleanor J Murray
AU - Jonathan A C Sterne
PY - 2026
DA - 2026/10/30
JO - Pharmacoepidemiology and drug safety
DO - 10.1002/pds.70507
UR - https://europepmc.org/article/MED/42893801
AB - 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 standardised protocol with predefined dose adjustments and a maximum dose of 150 μg/week. The outcome was all-cause mortality over 8 months.Results The study included 8628 patients from 10 centres between 2004 and 2016; 62% male, median age 66 years (IQR 52-76). At baseline, mean Hb was 97.7 g/L (SD 15.1), and 79% of patients were receiving darbepoetin. The hazard ratio for mortality was 0.92 (95% CI 0.75-1.12) for the 105-125 versus 95-115 g/L comparison, and 1.20 (95% CI 0.94-1.54) for the 125-145 versus 95-115 g/L comparison. Adherence to the highest Hb target was lower, limiting precision.Conclusions Targeting an Hb range of 105-125 g/L under controlled ESA dosing was not associated with increased mortality compared with 95-115 g/L. Targeting Hb levels above 125 g/L may increase mortality risk, consistent with previous trial findings.
SN - 1053-8569
SN - 1099-1557
ER -