• Am. J. Kidney Dis. · Nov 2013

    Association of a change in erythropoiesis-stimulating agent dose during hospitalization and subsequent hemoglobin levels and transfusions in hemodialysis patients.

    • Ben C Wong, Pietro Ravani, Braden J Manns, Adriane Lewin, Xin Zhang, Rick Chin, Brenda R Hemmelgarn, Marcello Tonelli, Matthew J Oliver, and Robert R Quinn.
    • University of Calgary, Calgary, Canada.
    • Am. J. Kidney Dis. 2013 Nov 1;62(5):947-52.

    BackgroundErythropoiesis-stimulating agent (ESA) doses are often increased in hospitalized dialysis patients in response to acute anemia with unknown consequences. We sought to determine whether increases in ESA dose during hospital admission were associated with changes in transfusion requirement and risk of exceeding recommended hemoglobin targets.Study DesignRetrospective cohort study.Setting & ParticipantsLinked administrative, laboratory, and blood transfusion data were used to identify a total of 700 hospitalizations involving 484 long-term hemodialysis patients between 2004 and 2008 in the Calgary Health Region, Canada.PredictorChange in ESA dose was determined by comparing the average weekly dose over the 6 weeks preceding admission to that administered during the 14 days following admission.Outcomes & MeasurementsCox proportional hazards models adjusted for baseline patient characteristics were used to model the association between changes in ESA dose and outcomes, including exceeding recommended hemoglobin targets, receipt of blood transfusion, cardiovascular outcomes, and death.ResultsThere was a significant increase in the risk of exceeding recommended hemoglobin targets as the ESA dose was increased by ≥40 μg/wk (equivalent darbepoetin alfa dose) above baseline (HR, 2.21; 95% CI, 1.19-4.10). However, an increase in ESA dose was not associated with reduced need for blood transfusion, risk of cardiovascular outcomes, or death.LimitationsResidual confounding by clinical events that may lead to changes in the management of patients and may have influenced the observed relationship between predictor and outcomes.ConclusionsIncreasing the ESA dose at hospitalization in hemodialysis patients is associated with higher risk of exceeding recommended hemoglobin targets, but does not appear to be associated with the need for transfusion, risk of cardiovascular outcomes, or death.Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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