Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Usage of the Anemia Control Model Is Associated with Reduced Hospitalization Risk in Hemodialysis

Mario Garbelli
,
Maria Eva Baro Salvador
,
Abraham Rincon Bello
ORCID logo ,
Diana Samaniego Toro
,
Francesco Bellocchio
,
Luca Fumagalli
,
Milena Chermisi
,
Christian Apel
,
Jovana Petrovic
ORCID logo ,
Dana Kendzia
,
Jasmine Ion Titapiccolo
,
Julianna Yeung
,
Carlo Barbieri
,
Flavio Mari
,
Len Usvyat
,
John Larkin
ORCID logo ,
Stefano Stuard
,
Luca Neri
* ORCID logo
Version 1 : Received: 18 September 2024 / Approved: 19 September 2024 / Online: 19 September 2024 (03:42:50 CEST)

How to cite: Garbelli, M.; Baro Salvador, M. E.; Rincon Bello, A.; Samaniego Toro, D.; Bellocchio, F.; Fumagalli, L.; Chermisi, M.; Apel, C.; Petrovic, J.; Kendzia, D.; Ion Titapiccolo, J.; Yeung, J.; Barbieri, C.; Mari, F.; Usvyat, L.; Larkin, J.; Stuard, S.; Neri, L. Usage of the Anemia Control Model Is Associated with Reduced Hospitalization Risk in Hemodialysis. Preprints 2024, 2024091460. https://doi.org/10.20944/preprints202409.1460.v1 Garbelli, M.; Baro Salvador, M. E.; Rincon Bello, A.; Samaniego Toro, D.; Bellocchio, F.; Fumagalli, L.; Chermisi, M.; Apel, C.; Petrovic, J.; Kendzia, D.; Ion Titapiccolo, J.; Yeung, J.; Barbieri, C.; Mari, F.; Usvyat, L.; Larkin, J.; Stuard, S.; Neri, L. Usage of the Anemia Control Model Is Associated with Reduced Hospitalization Risk in Hemodialysis. Preprints 2024, 2024091460. https://doi.org/10.20944/preprints202409.1460.v1

Abstract

Introduction. The management of anemia in chronic kidney disease (CKD-An) presents significant challenges for nephrologists due to variable responsiveness to erythropoietin-stimulating agents (ESA), hemoglobin (Hb) cycling, and multiple clinical factors affecting erythropoiesis. The Anemia Control Model (ACM) is a decision support system designed to personalize anemia treatment, which has shown improvements in achieving Hb targets, reducing ESA doses, and maintaining Hb stability. This study aimed at evaluating the association between ACM-guided anemia management with hospitalizations and survival in a large cohort of hemodialysis patients. Methods. This mul-ti-center, retrospective cohort study evaluated adult hemodialysis patients within the European Fresenius Medical Care NephroCare network from 2014 to 2019. Patients treated according to ACM recommendations were compared to those from centers without ACM. Data on demographics, comorbidities, and dialysis treatment were used to compute a propensity score estimating the like-lihood of receiving ACM-guided care. The primary endpoint was hospitalizations during follow-up; the secondary endpoint was survival. A 1:1 propensity score-matched design was used to minimize confounding bias. Results. A total of 20,209 eligible patients were considered (reference group: 17,101; ACM adherent group: 3,108). Before matching, the mean age was 65.3±14.5 years, with 59.2% men. Propensity score matching resulted in two groups of 1,950 patients each. Matched ACM adherent and non-ACM patients showed negligible differences in baseline characteristics. Hospi-talization rates were lower in the ACM group both before matching (71.3 vs. 82.6 per 100 per-son-years, p<0.001) and after matching (74.3 vs. 86.7 per 100 person-years, p<0.001). During fol-low-up, 385 patients died, showing no significant survival benefit for ACM-guided care (hazard ratio = 0.93; p=0.51). Conclusions: ACM-guided anemia management was associated with a sig-nificant reduction in hospitalization risk among hemodialysis patients. These results further support the utility of ACM as a decision support tool enhancing anemia management in clinical practice.

Keywords

End Stage Renal Disease (ESRD); anemia management; erythropoiesis stimulating agent (ESA); Artificial Intelligence (AI); Personalized Medicine

Subject

Medicine and Pharmacology, Urology and Nephrology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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