Results of the European Survey on Anaemia Management 2003 (ESAM 2003): current status of anaemia management in dialysis patients, factors affecting epoetin dosage and changes in anaemia management over the last 5 years
1 Service de Néphrologie, Hôpital La Pitié, Paris, France, 2 Ortho Biotech Europe, Baar, Switzerland and 3 Medians, Totnes, UK
Correspondence and offprint requests to: Professor Claude Jacobs, Service de Néphrologie, Hôpital de la Pitié, Salpêtrière, 83 Boulevard de l’Hôpital, 75013 Paris, France. Email: claude.jacobs{at}psl.ap-hop-paris.fr
The European Survey of Anaemia Management 2003 (ESAM 2003) was a 1 day randomized survey conducted to assess anaemia management in dialysis patients 4 years after the introduction of the European Best Practice Guidelines. The survey included 8100 patients from 11 European countries and Israel. Overall, haemoglobin (Hb) levels 
11.0 g/dl, as recommended by the guidelines, were achieved in 66% of patients. Only 48% of patients had adequate iron status, with transferrin saturation values missing for 27% and functional or absolute iron deficiency reported for 17 and 9%, respectively. In order to identify factors affecting epoetin dose and Hb levels, the countries were divided into two groups based on the percentage of patients with Hb levels 11.0 g/dl (>70% in group 1 and 60–70% in group 2). The most probable causes for better management in group 1 were administration of higher epoetin doses and better monitoring and management of iron status. In patients with Hb <11.0 g/dl, mean epoetin-
/ß doses were significantly lower for subcutaneous than intravenous (i.v.) administration, whereas mean doses were similar for both routes in patients with Hb 11.0 g/dl. When standardized for Hb levels, the dose ratio of i.v. epoetin-/ß to i.v. darbepoetin alfa was 176:1 (95% confidence interval, 166:1–189:1). Limited comparisons between the eight countries that participated in ESAM 2003 and the original ESAM revealed that many patients still have haemoglobin levels below the current recommendations despite significant improvements in management of renal anaemia over the last 5 years.
Keywords: anaemia; chronic kidney disease; dialysis; epoetin; erythropoietin; iron status
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