Epoetin requirements predict mortality in hemodialysis patients

Zhang, Yi; Thamer, Mae; Stefanik, Kevin; Kaufman, James S.; Cotter, Dennis J.

doi:10.1053/j.ajkd.2004.08.002

Cited by 170 publications

(103 citation statements)

References 36 publications

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“…In epo-treated patients, falling Hgb increases mortality risk and rising Hgb reduces mortality risk (28). Poor responders to epo who continue to receive high doses of epo have increased mortality (29). These observations may be accounted for by improvement or deterioration in patient's health.…”

Section: Discussionmentioning

confidence: 99%

Serum Albumin Is Strongly Associated with Erythropoietin Sensitivity in Hemodialysis Patients

Agarwal

Davis

Smith

2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: In hemodialysis patients, the hematological response to erythropoietin (epo) is variable and clinical factors that explain this variability are incompletely understood. We tested the hypothesis that the variability in hemoglobin (Hgb) response (epo sensitivity) is determined by key nutritional, inflammation, and oxidative stress markers.Design, setting, participants, & measurements: Eighty-two consecutive patients on hemodialysis had 3 consecutive monthly predialysis evaluations of Hgb, total white blood cell (WBC) count, serum albumin, malondialdehyde (MDA), and monocyte chemoattractant protein-1 (MCP1). We analyzed the time course of Hgb in relationship to serum albumin, WBC, MDA, MCP1, epo and iron administration, and tests of iron sufficiency in a linear growth curve model.Results: Subjects with higher Hgb had a fall in Hgb and vice versa, regressing to a mean Hgb (SD) of 11.8 g/dl (1.8 g/dl). Whereas the average slope of Hgb was flat, the SD of slopes was 0.63 g/dl, which explained 39% of the variance in Hgb. Nonuse of epo was associated with a mean Hgb change of ؊0.18 g/dl (95% confidence interval [CI] ؊0.26 to ؊0.10) per 10,000 IU epo/mo (P < 0.05). Epo use was associated with steeper rate of change at 0.04 g/dl per mo per 10,000 IU (95% CI 0.01 to 0.07) (P < 0.01). Hgb at baseline was 0.73 g/dl higher for each 1-g/dl increase in albumin, and the rate of change increased by 0.49 g/dl per mo for each 1-g/dl increase in albumin concentration. WBC, MDA, or MCP1 had no role in predicting the baseline Hgb or its change over time.Conclusions: Serum albumin concentration is an important predictor of both baseline Hgb and epo sensitivity in chronic hemodialysis patients. Factors that improve serum albumin may also improve Hgb in hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Serum Albumin Is Strongly Associated with Erythropoietin Sensitivity in Hemodialysis Patients

Agarwal

Davis

Smith

2008

Clinical Journal of the American Society of Nephrology

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“…In the FDA reanalysis of the CHOIR and Normal Hematocrit studies, dosage was analyzed but without adjustment for confounding and was separately considered from the analysis of rate of increase of Hb (11). There are now several analyses that suggest an effect of ESA dosage on adverse clinical outcome in the treatment of CKD anemia (17)(18)(19). This issue is reviewed more extensively elsewhere (20).…”

Section: T He Trial To Reduce Cardiovascular Endpoints Withmentioning

confidence: 99%

The FDA's Perspective on the Risk for Rapid Rise in Hemoglobin in Treating CKD Anemia

Singh¹

2010

Clinical Journal of the American Society of Nephrology

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“…O bservational studies using the United States Renal Data System (USRDS) show that patients requiring higher doses of epoetin alfa (EPO) are at greater mortality risk (1,2). However, these patients have a higher prevalence of comorbid conditions and other characteristics associated with poorer prognosis (3)(4)(5).…”

mentioning

confidence: 99%

“…We demonstrated previously (3) that adjustment for confounding variables available in dialysis provider data but unavailable in USRDS attenuated the EPO dose-mortality association (1,2). Here, we use an MSM to examine the association between EPO dose and mortality, adjusting for time-dependent confounding.…”

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confidence: 99%