Key result
Darbepoetin alfa shows no all-cause mortality difference versus epoetin alfa in incident hemodialysis patients.
Why the study?
Adequately powered studies directly comparing hard clinical outcomes of darbepoetin alfa versus epoetin alfa in patients undergoing dialysis are lacking.
Does darbepoetin alfa compared to epoetin alfa reduce mortality and cardiovascular events in incident hemodialysis patients?
Population
19,932 incident hemodialysis patients in US nonchain facilities
Comparison
Darbepoetin alfa versus epoetin alfa assigned at facility level
Design
Observational registry-based retrospective cohort study mimicking cluster-randomized trial
Follow-up
21,918 person-years
Authors
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Similar mortality with darbepoetin versus epoetin in incident hemodialysis; observational data leave open whether agents are interchangeable.
Cohort (n=19,932)
Yes
Does darbepoetin alfa compared to epoetin alfa reduce mortality and cardiovascular events in incident hemodialysis patients?
Hazard Ratio: 1.05 (95% CI 0.99–1.12)
In incident hemodialysis patients, treatment at facilities predominantly using darbepoetin alfa versus epoetin alfa resulted in similar rates of mortality and cardiovascular events.
Winkelmayer et al. (2015) conducted a cohort in End-Stage Renal Disease (ESRD) initiating hemodialysis (n=19,932). Darbepoetin alfa vs. Epoetin alfa was evaluated on All-cause mortality (HR 1.05, 95% CI 0.99-1.12). In incident hemodialysis patients, facility-level exposure to darbepoetin alfa versus epoetin alfa was not associated with a difference in all-cause mortality (HR 1.05; 95% CI 0.99-1.12).
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