Renal Anemia: Comparing Current Eastern and Western European Management Practice (ORAMA)

Figures & data

Figure 1. Study design.

Table 1 Demographics and baseline characteristics of all patients by region

	Total N = 739	Western Europe N = 346	Eastern Europe N = 393
Gender, men (%)	368 (50)	174 (50)	194 (49)
Age, y, mean (SD)	59 (15)	64 (14)	55 (14)
Weight, kg, mean (SD)	72 (15)	73 (16)	70 (14)
Systolic blood pressure, mmHg, mean (SD)	135 (18)	135 (19)	135 (17)
Diastolic blood pressure, mmHg, mean (SD)	79 (10)	77 (11)	81 (10)
Patients on dialysis, %	81	77	85
Cause of chronic renal failure
Diabetic nephropathy, %	19	28	12
Hypertensive nephrosclerosis, %	20	26	14
Glomerulonephritis, %	29	23	34
Polycystic kidney disease, %	9	7	10
Pyelonephritis/interstitial nephritis	18	10	25
Other cause	16	19	14
Most frequent concomitant diseases
Diabetes mellitus, %	27	40	16
Cardiovascular disease, %	47	52	43
Use of concomitant medications at baseline
ACE inhibitors, N (%)	322 (44)	177 (51)	145 (37)
Beta blockers, N (%)	311 (42)	177 (51)	134 (34)
Other antihypertensive medication, N (%)	307 (42)	112 (33)	195 (50)
Patients on dialysis, N (%)	599 (81)	266 (77)	333 (85)
Patients on hemodialysis, N (%)	567 (95)	243 (91)	324 (97)
Mean length of dialysis, months (SD)	51 (52)	50 (55)	51 (50)
Kt/V, mean (SD)	1.35 (0.23)	1.44 (0.20)	1.30 (0.23)
Kt/V >1.2, N (%)	261 (73)	99 (86)	162 (67)
Frequency of hemodialysis/week
Twice, %	3	3	3
Three times, %	92	94	91
Four or more times, %	5	4	6

*p < 0.0001, Western Europe vs. Eastern Europe.

Abbreviations: N = number of patients, Hb = hemoglobin, ACE = angiotensin-converting enzyme, SD = standard deviation.

Table 2 Anemia treatment among dialysis patients by region

	Total N = 599	Western Europe N = 266	Eastern Europe N = 333
ESA	576 (96)	264 (100)	312 (94)
Epoetin alfa	100 (17)	32 (12)	68 (22)
IV	97 (97)	31 (97)	66 (97)
Median weekly dose, IU	8,000	9,000	8,000
SC	3 (3)	1 (3)	2 (3)
Median weekly dose, IU	18,000	18,000	19,500
Epoetin beta	431 (75)	199 (75)	232 (74)
IV	126 (29)	101 (51)	25 (11)
Median weekly dose, IU	6,000	6,000	2,000
SC	305 (71)	98 (49)	207 (89)
Median weekly dose, IU	6,000	6,000	5,000
Darbepoetin alfa	45 (8)	33 (13)	12 (4)
IV	26 (58)	14 (42)	12 (100)
Median weekly dose, μg	20	30	18
SC	19 (42)	19 (58)	0
Median weekly dose, μg	20	20	NA
Iron	389 (65)	175 (66)	214 (64)
IV iron	343 (85)	160 (90)	183 (81)
Oral iron	61 (15)	17 (10)	44 (19)

Data are number of patients (%).

*With iron therapy multiple answers were possible (i.e., a patient could be on both intravenous and also oral iron therapy).

Abbreviations: N = number of patients, ESA = erythropoiesis-stimulating agent, IV = intravenous, SC = subcutaneous.

Table 3 Hematological parameters by region for dialysis and non-dialysis patients

	Total	Western Europe	Eastern Europe
Dialysis patients
Number of patients, N	599	265	333
Baseline Hb, g/dL, mean (SD)	11.1 (1.4)	11.8 (1.2)^││	10.6 (1.3)^││
Mean Hb, g/dL, mean (SD)	11.0 (1.3)	11.7 (1.1)	10.5 (1.2)
Mean Hb >11 g/dL, N (%)	300 (50)	199 (75)	101 (30)
All Hb >11g/dL, N (%)^†	214 (36)	151 (57)^││	63 (19)^││
Mean stable Hb 10–12 g/dL, N (%)	321 (54)	137 (52)	184 (55)
Stable Hb 10–12 g/dL, N (%)^†	166 (28)	69 (26)	97 (29)
Ferritin, μg/L, mean (SD) ^‡	478 (411)	602 (402)^││	379 (391)^││
Ferritin >100 μg/L, N (%)^‡	488 (85)	231 (91)│^│	257 (80)^││
TSAT, %, mean (SD) ^§	30 (11)	28 (11)	31 (11)
TSAT >20%, N (%)^§	384 (81)	143 (74)^││	241 (86)^││
Non-dialysis patients
Non-dialysis patients, N	140	80	60
Baseline Hb, g/dL, mean (SD)	11.4 (1.4)	11.3 (1.4)	11.6 (1.5)
Mean Hb, g/dL, mean (SD)	11.3 (1.2)	11.2 (1.2)	11.4 (1.3)
Mean Hb >11 g/dL, N (%)	83 (59)	45 (56)	38 (63)
All Hb >11g/dL, N (%)^†	59 (42)	33 (41)	26 (43)
Mean stable Hb 10–12 g/dL, N (%)	79 (56)	49 (61)	30 (50)
Stable Hb 10–12 g/dL, N (%)^†	40 (29)	27 (34)	13 (22)
Ferritin, μg/L, mean (SD) ^‡	158 (138)	200 (149)^││	115 (113)^││
Ferritin >100 μg/L, N (%)^‡	62 (52)	40 (67)^││	22 (37)^││
TSAT, %, mean (SD)^§	29 (10)	24 (11)^││	31 (9)^││
TSAT >20%, N (%)^§	74 (78)	20 (57)^││	54 (90)^││

*Mean of measurements at baseline and over a three-month pre-study period prior to enrolment (pre-study phase).

^†Meeting the EBPG target values (all individual measurements at baseline and over the pre-study period).

^‡Data missing: dialysis patients: West n  = 10 (5%), East n = 12 (4%); non-dialysis patients: West n = 20 (25%).

^§Data missing: dialysis patients: West n = 71 (27%), East n = 51 (16%); non-dialysis patients: West n = 20 (25%).

^││p < 0.002.

Abbreviations: N = number of patients, Hb = hemoglobin, TSAT = transferrin saturation.

Figure 2. Mean Hb in dialysis patients at baseline by country.