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Abstract: SA-PO826

Patterns of Anemia Management and Response in the Predialysis Period

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States
  • Yan, Heng, Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gilbertson, David T., 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
  • Li, Suying, Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background

The management of anemia in the predialysis period has not been fully described.

Methods

We used USRDS ESRD and pre-ESRD files to study patients initiating hemodialysis (HD) between April 1, 2012 and June 30, 2013. Patients had to have a hemoglobin (Hb) measurement at HD initiation and at least one other measurement in the 3 months after, in the absence of a blood transfusion. Patients were divided into those with predialysis Hb ≥ 9.0 g/dL and those <9.0 g/dL. Percent of patients receiving ESAs and associated Hb levels before and after dialysis initiation were reported.

Results

Of 20,454 patients, 15,599 (76%) had predialysis Hb ≥ 9.0 g/dL. Of those with Hb ≥ 9.0 g/dL, 11,694 (75%) did not require ESAs; mean predialysis Hb was 10.4 ± 1.1 g/dL. The remaining 25% required ESAs, attaining a predialysis Hb level of 10.3 ± 0.9 g/dL. Of 4855 (24% of the total) who had predialysis Hb <9.0 g/dL, only 1293 of these (27%) received ESAs; mean predialysis Hb was 8.2 ± 0.7 g/dL; the remainder (73%) with Hb < 9.0 g/dL did not receive ESAs and had a predialysis Hb level of 8.2 ± 0.8 g/dL. Only 183 (4%) proved poorly responsive to ESAs after initiation, with Hb increasing from 7.9 ± 1.1 g/dL (predialysis) to only 8.5 ± 0.7 g/dL (postinititiation). Of the 4461 (92%) who responded to ESAs after initiation, Hb increased markedly from 8.2 g/dL (predialysis) to 10.9 ± 1.2 g/dL (postinitiation).

Conclusion

One quarter of patients had predialysis Hb < 9.0 g/dL, of whom only one-quarter received ESAs. Since only 1 in 20 patients with Hb < 9.0 g/dL subsequently proved to be poorly responsive to ESAs after initiation, the vast majority of patients with predialysis Hb <9.0 g/dL appear to have been “rescuable” from anemia, suggesting that opportunities to effectively treat predialysis anemia are being missed.

Funding

  • Commercial Support