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Abstract: FR-PO740

Erythropoietin-Stimulating Agent Dose Not Associated with Patient Transition to Nocturnal In-Center Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Wilk, Adam S., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
  • Hoge, Courtney E., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
  • Plantinga, Laura, Emory University School of Medicine, Atlanta, Georgia, United States
  • Lea, Janice P., Emory University School of Medicine, Atlanta, Georgia, United States
Background

Nocturnal dialysis (ND) can support longer sessions with better clearances of uremic toxins, compared to traditional in-center hemodialysis (HD). It has been suggested that patients with improved clearances may have improved responses to erythropoietin-stimulating agents (ESAs). We compared use of ESAs for ND patients before and after they initiated ND treatment.

Methods

We identified ND patients at a medium-sized dialysis organization to be those HD patients for whom ≥80% of dialysis sessions were ND sessions—starting at 6:30pm or later and lasting ≥5 hours—over the 3 months after their first ND session (≥20 sessions total) during 2010-16. Outpatient dialysis session and administered ESAs data were extracted for these patients within 12 months of ND transition (pre and post). Epogen units administered per month before December 2012 (when the organization switched to Aranesp) were converted to approximately equivalent Aranesp mcg/month dosages to support a single measure of ESA use per patient-month. Descriptive analyses of ESA use were performed for all months with ≥7 sessions (i.e., still in care). The effects of post-transition ND care status on ESA use were estimated using a generalized linear model (GLM) with a Gaussian distribution and random intercepts and slopes; standard errors were clustered at the patient level.

Results

We identified 64 ND patients (4.7% of 1,357 eligible patients in care), with 354 pre-transition patient-months (3,974 sessions) and 496 post-transition patient-months (5,841 sessions). Across descriptive analyses and GLM analyses accounting for patient-level clustering, we found no statistically significant differences in ESA use post-transition. We estimated ESA use levels of 158.3 mcg/month post-transition versus 147.1 pre-transition (p=0.24) in descriptive analyses, and our GLM point estimate associated with post-transition was +5.5 mcg/month (p=0.69).

Conclusion

After transitioning to ND, patients may not experience any change in their ESA use. Further studies are needed to more fully assess any changes in patients’ anemia management, including iron use; these analyses should also account for potential differences in Kt/V, hemoglobin, and other lab results.