Effectiveness of recombinant human erythropoietin, vitamin D3and iron therapy on long-term survival of patients with end-stage renal disease receiving haemodialysis: analysis of 702 patients after 10-year follow-up

Abstract

AbstractObjectiveFew studies have been conducted to investigate the influence of recombinant human erythropoietin (rhEPO) on the long-term prognosis of end-stage renal disease (ESRD).DesignA retrospective cohort study.SettingThe largest regional hospital renowned for haemodialysis in northern Taiwan.SubjectsA total of 702 ESRD patients undergoing haemodialysis between 1993 and 2002 were evaluated.ResultsThe rate of overall use of rhEPO, vitamin D3or Fe therapy was 62 %. The 10-year survival rate in patients with rhEPO supplementation was statistically more favourable than that in patients without rhEPO (hazard ratio (HR) = 0·38, 95 % CI 0·30, 0·47,P< 0·0001). Similar findings were noted for patients receiving vitamin D3(HR = 0·36, 95 % CI 0·21, 0·64,P= 0.0004) and Fe (HR = 0·45, 95 % CI 0·33, 0·61,P< 0·0001). After adjusting for age, education and aetiology, the administration of rhEPO resulted in statistically significant improvements in long-term survival rate either with (HR = 0·30, 95 % CI 0·22, 0·42) or without (HR = 0·48, 95 % CI 0·38, 0·61) combined use of Fe or vitamin D3.ConclusionsWe demonstrated a reduction in long-term mortality related to supplementation therapy with rhEPO, vitamin D3and Fe. The findings provide a justification for the administration of combined supplement therapy in patients undergoing haemodialysis.