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Abstract: SA-PO820

Development and Validation of a Transfusion Risk Score

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism


  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Yan, Heng, Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Xu, Hairong, Astrazeneca, Westlake Village, California, United States
  • Sinsakul, Marvin V., AstraZeneca, Bethesda, Maryland, United States
  • Peng, Yi, Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States
  • Liu, Jiannong, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States
  • Li, Suying, Chronic Disease Research Group, Minneapolis, Minnesota, United States

Following changes to CMS payment for dialysis services in Jan 2011 and the ESA label revision 6 months later, a decline in hemoglobin (Hb) levels and an increase in transfusions were observed in dialysis patients. Transfusions have decreased from their 2012 peak, and transfusion avoidance is the preferable option in dialysis patients. We sought to develop a predictive model for transfusions using comorbidity, markers of inflammation, previous transfusion, vitamin D use, IV iron use, ESA dose, Hb, ferritin and TSAT.


USRDS/Crownweb data from 2012-13 were used for model development. Point prevalent hemodialysis (HD) patients on 11/1/12 with ≥ 6 months Medicare A/B coverage and mean Hb < 10 g/dL were included. Aug-Oct were used to assess anemia-related variables (Hb, ESA, TSAT, ferritin, IV iron use, vitamin D, and transfusion), and May-Oct were used to assess comorbidity from claims. Logistic regression with Lasso for variable selection was used to predict transfusion during the next 3 months. For model validation, similar cohort construction was used, with point prevalent HD patients on 8/1/13.


Variables retained in the final model included Hb, ESA dose, ferritin, TSAT, IV iron, vitamin D, prior transfusion, and interactions of these variables. In the validation dataset, a calibration plot showed good agreement between observed/predicted transfusions (Figure): c-statistic = 0.74.


The addition of ferritin and TSAT, along with inflammatory comorbidities, aided in prediction of transfusions in patients with Hb levels < 10 g/dL. Optimal anemia management strategies involve balancing CV risk on the high end of Hb and ESA exposure with transfusion risk on the low end. The ability to identify patients at risk for transfusion may lead to improved anemia management and outcomes.


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