Supplementary Material for: The use of Anemia Control Model is Associated with Improved Hemoglobin Target Achievement, Lower Rates of Inappropriate Erythropoietin Stimulating Agents and Severe Anemia Among Dialysis Patients

INTRODUCTION
The Anemia Control Model (ACM) is a certified medical device suggesting the optimal ESA and iron dosage for patients on hemodialysis. We sought to assess the effectiveness and safety of ACM in a large cohort of hemodialysis patients.
METHODS
This is a retrospective study of dialysis patients treated in Nephrocare centers between 01-06-2013 and 31-12-2019. We compared patients treated according to ACM suggestions and patients treated in clinics where ACM was not activated. We stratified patients belonging to the reference group by historical target achievement rates in their referral centers (tier 1: <70%; tier 2: 70%-80%; tier 3: >80%). Groups were matched by propensity score.
RESULTS
After matching, we obtained four groups with 85512 patient-months each. ACM had 18% higher target achievement rate, 63% smaller inappropriate ESA administration rate, and 59% smaller severe anemia risk compared to Tier 1 centers (all p<0.01). The corresponding risk ratios for ACM compared to Tier 2 centers were 1.08 (95% CI: 1.08 - 1.09), 0.49 (95% CI: 0.47 - 0.51), and 0.64 (95% CI: 0.61 - 0.68); for ACM compared to Tier 3 centers, 1.01 (95% CI: 1.01 - 1.02), 0.66 (95% CI: 0.63 - 0.69), and 0.94 (95% CI: 0.88 - 1.00), respectively. ACM was associated with statistically significant reductions in ESA dose administration.
CONCLUSION
ACM was associated with increased hemoglobin target achievement rate, decreased inappropriate ESA usage and a decreased incidence of severe anemia among patients treated according to ACM suggestion.