Treatment of CKD Anemia in Octogenarians: A Comparison of Epoetin Alfa (EPO) in Elderly (65–79; >/=80) and Non-Elderly (<65) Patients.
Authors: Fink Jeffrey C. , Yektashenas Behin H. , Blasi Michael V. , Klausner Mark A. , Woodman Richard C. , Provenzano Robert 
Published: October 2019

Background: Anemia in the elderly is associated with significant medical consequences even with mild reductions in hemoglobin (Hb). These include worsening physical disability and heart failure. CKD is a common treatable cause of anemia in the elderly. Given the limited published data on epoetin alfa (EPO) therapy in octogenarians, we evaluated whether responses to QW EPO therapy in patients (pts) with anemia due to CKD were influenced by age.

Objective: A subset analysis comparing 2 groups of elderly pts (Group 1: 65–79 years (y), Group 2: >/=80y) vs non-elderly (<65y) pts with anemia of CKD not on dialysis was performed on the dataset of a recently completed multicenter, prospective, open-label study examining response to QW EPO therapy. Efficacy was assessed by changes in Hb and transfusion requirements.

Methods: All pts had entry Hb </=10g/dL and received EPO at a starting dosage of 10,000U SC QW for 16 weeks (w) titrated to 20,000U SC QW after 4w if Hb increased by <1g/dL.

Results: Of 1338 pts evaluable for efficacy, 531 (40%) were 65–79y (mean age 72.5±4.2y; 55% women), 186 (14%) were >/=80y (mean age 84.8±3.6y; 58% women) and 621 (46%) <65y (mean age 52.0±10.5y; 62% women). Baseline (BL) characteristics between groups revealed those <65y, both 65–79y and >/=80y pts with CKD had significant reductions in calculated CrCL, lower SCr, and lower body weight despite comparable mean BL Hb (table). Mean Hb change from BL to final assessment was similar in all three groups (2.4±1.5g/dL for both <65y and 65–79y and 2.4±1.4g/dL for >/=80y). Responses to EPO were seen by weeks 4 and 8 (65–79y, 47.8% and 80.2%, >/=80y, 49.5% and 79.0% and <65y, 52.3% and 83.3%). The overall number of pts responding to EPO (Hb increase >/=2g/dL at any point from BL) was 471 (88.7%) in 65–79y; 166 (89.3%) in >/=80y and 564 (90.8%) in <65y. The percent of pts transfused at BL (65–79y, 10.0% >/=80y, 14.0% vs. <65, 11.3%; p=0.4794 and p=.3173 respectively) and during study was similar for all age groups assessed. Though mean weekly EPO doses were similar for all groups (65–79y, 11,331±3364U/w >/=80y, 11,251±3401U/w, <65, 11,514±3538 U/w), mean body weight dosing was significantly higher in both the 65–79y and >/=80y groups (150.0±50.7U/kg/w, 172±66.3U/kg/w vs <65, 140.0±56.9U/kg/w, p=.0018 and p<.0001 respectively). QW EPO was well tolerated in all three age groups and adverse events were those as previously reported.

Conclusions: Though octogenarians with anemia due to pre-dialysis CKD have worse renal function, more comorbidities and presumably less marrow reserve, their response to doses of QW EPO is similar to younger adults. These data suggest that the “oldest old” have comparable Hb responses to EPO demonstrating that age is not a limiting factor in the administration of EPO therapy for CKD anemia. This response may in part be due to higher body weight dosing of EPO.

Table 1

BL Characteristic (N ± SD) <65 years (n=621) 65–79 years (n=531) >/=80 years (n=186) p-value Calculated CrCL (mL/min) 31.5 ± 15.1 23.1 ± 9.6 17.1 ± 6.8 p< .0001 for both Scr (mg/dL) 3.5 ± 1.1 3.2 ± 1.0 3.1 ±1.0 p= .0004 (<65 vs 65–79) p= .0003 (<65 vs >/=80) Body weight (kg) 88.1 ± 25.9 78.8 ± 19.3 68.7 ± 14.7 p< .0001 for both Mean Baseline Hb (g/dL) 9.1 ± 0.7 9.2 ± 0.7 9.2 ± 0.7 not significant