Effectiveness of recombinant human erythropoietin, vitamin D₃ and iron therapy on long-term survival of patients with end-stage renal disease receiving haemodialysis: Analysis of 702 patients after 10-year follow-up

Objective: Few studies have been conducted to investigate the influence of recombinant human erythropoietin (rhEPO) on the long-term prognosis of end-stage renal disease (ESRD).Design: A retrospective cohort study.Setting: The largest regional hospital renowned for haemodialysis in northern Taiwan.Subjects A total of 702 ESRD patients undergoing haemodialysis between 1993 and 2002 were evaluated.Results: The rate of overall use of rhEPO, vitamin D₃ or 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.Conclusions: We demonstrated a reduction in long-term mortality related to supplementation therapy with rhEPO, vitamin D₃ and Fe. The findings provide a justification for the administration of combined supplement therapy in patients undergoing haemodialysis.