Abstract: SA-PO801

Definition and Validation of a Novel Metric to Assess Erythropoiesis Stimulating Agent Response in Hemodialysis Patients

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Meaney, Calvin J., University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, United States
  • Karas, Spinel, The University of North Carolina, Durham, North Carolina, United States
  • Robinson, Ben, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, United States
  • Gaesser, Jamie L, University at Buffalo, Glen Mills, Pennsylvania, United States
  • Forrest, Alan, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, United States
  • Krzyzanski, Wojciech, University at Buffalo, Glen Mills, Pennsylvania, United States
  • Panesar, Mandip, None, Williamsville, New York, United States
  • Rao, Gauri G, University of North Carolina, Chapel Hill, North Carolina, United States
Background

Erythropoiesis stimulating agents (ESA) are the primary treatment of anemia in end-stage renal disease (ESRD) patients. Hemoglobin variability in and out of a narrow target range is common and associated with higher mortality and/or morbidity. More robust metrics of ESA response are needed to define optimal dosing and association to clinical outcomes.

Methods

In this cross-sectional, single-center, retrospective study, 49 ESRD patients on hemodialysis were followed for 12 months. To quantify the excursion of hemoglobin outside the target range (10-12g/dl), the area-under-the-curve of hemoglobin versus time over a 12-month period (AUC-HGB) was calculated using the trapezoidal rule. Patients were categorized into 4 responder groups based on AUC-HGB quartiles. Comparative analysis of demographic and clinical characteristics between responder groups was performed using Chi-square and Kruskal Wallis tests as appropriate. Spearman correlations between AUC-HGB, erythropoietin resistance index (ERI) and time within therapeutic range (TTR) were performed.

Results

There were no significant differences in demographics, laboratory, or dialysis parameters between responder groups except hemoglobin and ESA dose. The mean age was 58.0±13.1 years, 59% were male and 69% were African-American. Mean hemoglobin was 10.4±0.58g/dl (range 6.0-13.6g/dl). The median (range) AUC-HGBs for each group were: 4.45 (0-20) g x year/dL in the excellent responder group; 48.2 (26-65) g x year/dL in the good responder group; 101 (76-109) g x year/dL in the fair responder group; and 201 (123-528) g x year/dL in the poor responder group. There was a negative correlation with AUC-HGB and TTR (r=-0.93, p<0.001) and hemoglobin concentration (r=-0.85, p<0.01), while there was a positive correlation with AUC-HGB and ERI (r=0.70, p<0.001). The poor response group received higher median ESA dose (160 U/kg/week) compared to the excellent response group (68.8 U/kg/week, p<0.001) with a similar number of ESA dose changes between the groups. Over 2 years of follow-up, 5 patients died, of which 3 were in the poor response group.

Conclusion

AUC-HGB is a valid metric of ESA response in the hemodialysis population and may serve as a better marker of ESA response compared to conventional metrics.