Surveyed Nephrologists Report Significant Declines in the Use of ESAs in Hemodialysis and Peritoneal Dialysis Patient Populations, Compared with a Year Ago

Interest in ZS-9 and Patiromer is High After Review of Respective Product Profiles, According to Findings from Decision Resources Group

April 9, 2014 – Burlington, Mass. Decision Resources Group (DRG) finds that surveyed nephrologists report significant declines in the use of erythropoiesis-stimulating agents (ESAs) in hemodialysis (HD) and peritoneal dialysis, while ESA use in stage 4 use has remained statistically flat and use in stage 3 has increased compared with Q1 2013.  
Other key findings from the report entitled TreatmentTrends: Nephrology (US) Q1 2014:
  • Nephrologist perception of biosimilars: The majority of surveyed nephrologists believe that biosimilars (in general and for epoetin alfa) are very similar or somewhat similar to their branded protein product counterparts.
  • Percentage of patients on oral iron: Six months from now, surveyed nephrologists expect oral iron use to increase in HD and remain statistically flat in peritoneal dialysis, stage 4 and stage 3.
  • American Regent’s Injectafer: This intravenous iron, which was approved in July 2013, has reached low single digit chronic kidney disease non-dialysis reported patient share.
  • Rockwell Medical’s Triferic (SFP): A New Drug Application has recently been submitted to the FDA and, compared with Q1 2013, mean familiarity with Triferic, an iron compound that is delivered to HD patients via the dialysate, has significantly increased.
  • Need for new therapies: The greatest perceived need for new therapies among a list of common areas in nephrology include: slowing the progression of kidney disease, diabetic nephropathy, acute kidney injury, polycystic kidney disease and glomerulonephritis. (A DRG report publishing later this year will cover the topic of diabetic nephropathy.)
  • Compliance: Based on common medications prescribed to patients with chronic kidney disease, surveyed nephrologists believe that pre-dialysis patients are most compliant with diuretics, significantly more than with iron therapies, renin inhibitors and phosphate binders.
  • Bundling: General impressions on bundling are more positive since the bundling program started almost three years ago. In Q1 2014, about 29 percent of nephrologists viewed bundling positively versus 12 percent in Q1 2011. Based on mean ratings, surveyed nephrologists are under the most pressure to restrict measurement of nonessential labs, to have more-stringent hemoglobin targets resulting in less ESA use and to use more iron at the expense of ESAs.
Comments from Decision Resources Group Director Rob Dubman:
  • “It is not surprising that nephrologists are reporting continued dialysis declines in the use of ESAs, because we have observed this in our ChartTrends Renal Anemia series as well, which are studies of nephrologists submitting information from patient charts.”
  • “In terms of the renal pipeline, surveyed nephrologists’ perceptions of ZS Pharma’s ZS-9 and Relypsa’s patiromer are both high after reviewing their product profiles. These are late-stage agents in development for the treatment of hyperkalemia. This finding is in line with the fact that this study also found that the need for new hyperkalemia treatment options was rated a 6.9 on a scale of 1-10, with 10 being a high need for an improved therapy.”

About BioTrends Research Group
BioTrends Research Group provides syndicated and custom primary market research to pharmaceutical manufacturers competing in clinically evolving, specialty pharmaceutical markets. For information on BioTrends publications and research capabilities, please contact us at (610) 321-9400 or www. Bio-Trends. com. BioTrends is a Decision Resources Group company.

About Decision Resources Group
Decision Resources Group is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources Group at


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