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Abstract: SA-PO799

Association of Predialysis ESA Anemia Treatment with Mortality after Dialysis Initiation

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism


  • Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States
  • Li, Suying, 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
  • Liu, Jiannong, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States

Whether treatment of anemia in the setting of CKD prior to hemodialysis (HD) initiation may reduce post-initiation mortality is unknown.


Patients who initiated HD between April 1, 2012 and June 30, 2013 were identified from USRDS end-stage renal disease (ESRD) and pre-ESRD files. Hemoglobin (Hb) measurements at HD initiation and at least one other measurement in the subsequent 3-months, in the absence of transfusion, were required. Patients who either never had anemia (defined as Hb ≥ 9.0 g/dL) in the absence of treatment or those who had persistent post-initiation anemia despite treatment were eliminated. Patients who were consistently well-treated (Hb ≥ 9.0 g/dL) with ESAs were retained and compared with patients who appeared to have untreated or ineffectively-treated anemia prior to HD initiation, provided the latter responded to ESAs after initiation. Cox PH models, adjusted for patients’ demographics and comorbidities, were used to calculate the hazard ratio of all-cause and cardiovascular (CV) mortality after HD initiation.


The study sample was comprised of 3662 consistently well-treated patients and 4461 patients in the compared group. Adjusted risks of outcomes are shown in the Figure. All-cause mortality was significantly less for the consistently well-treated patients at 3 (HR 0.79, 95% CIs 0.65-0.95), 6 (HR 0.80, 95% CIs 0.69-0.93), and 12 (HR 0.83, 0.73 – 0.93) months. A similar pattern was observed for CV mortality at 3 (HR 0.74, 95% CIs 0.54-1.00), 6 (HR 0.74, 95% CIs, 0.59-0.94) and 12 (HR 0.78, 95% CIs 0.64-0.94) months.


Failure to achieve Hb ≥ 9.0 g/dL through lack of treatment in the predialysis period may represent missed treatment opportunity to reduce mortality after HD initiation.

Risk of all-cause and cardiovascular mortality in patients with consistently well-treated predialysis anemia (Hb at least 9.0 g/dL) compared to those patients who were not adequately treated but who later proved to be treatable after dialysis initiation.


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