Kidney Week

Abstract: SA-PO826

Patterns of Anemia Management and Response in the Predialysis Period

Session Information

• Dialysis: Anemia and Iron Metabolism
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 605 Dialysis: Anemia and Iron Metabolism

Authors

• Wetmore, James B., Hennepin County Medical Center, Minneapolis, Minnesota, United States

James B. Wetmore,

• Yan, Heng, Chronic Disease Research Group, Minneapolis, Minnesota, United States

Heng Yan,

• Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States

David T. Gilbertson,

• Xu, Hairong, Astrazeneca, Westlake Village, California, United States

Hairong Xu,

• Sinsakul, Marvin V., AstraZeneca, Bethesda, Maryland, United States

Marvin V. Sinsakul,

• Peng, Yi, Chronic Disease Research Group, Minneapolis, Minnesota, United States

Yi Peng,

• Liu, Jiannong, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, United States

Jiannong Liu,

• Li, Suying, Chronic Disease Research Group, Minneapolis, Minnesota, United States

Suying Li,

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 –