Abstract: SA-PO251
Impact of a Novel Dose Calculation Method for Erythropoiesis Stimulating Agents on Renal Anemia Therapy in Hemodialysis Patients
Session Information
- Anemia and Iron Metabolism: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 202 Anemia and Iron Metabolism: Clinical
Authors
- Fujikawa, Tetsuya, Yokohama National University, Yokohama, Kanagawa, Japan
- Kuji, Tadashi, Yokodai Central Clinic, Yokohama, KANAGAWA, Japan
- Shibata, Kazuhiko, Yokohama Minami Clinic, Yokohama, Japan
Background
Patients with end-stage renal disease requiring dialysis therapy have poor prognosis compared with normal population. Renal anemia is a common comorbidity and is a major cause of morbidity and mortality among hemodialysis patients. For treatment of renal anemia, empiric erythropoiesis stimulating agents (ESA) dosing method is generally used in hemodialysis patients and standardized method are shown by Fishbane et al. in 2005. However, hemoglobin (Hb) levels are not always within target range for favorable prognosis according to anemia guidelines. We developed a new method for ESA dose determination that uses individual increase value and individual decrease value calculated from Hb variability. Individual increase value and individual decrease value mean real response of Hb increase under maximum ESA dose and natural Hb decrease without ESA per week, respectively. There has never been a reliable and valid method to calculate individual increase and decrease values before the new method. The aim of this study was to estimate effectiveness of the new method for ESA dosing.
Methods
This was a 6-month randomized, controlled, parallel-group study in hemodialysis patients with renal anemia treatment. Patients were assigned to two groups receiving epoetin beta (EPO) dosing by new method and standardized method. The target range of Hb was set at 10.0 to 11.0 g/dL. EPO doses for two weeks were determined at every two-week Hb measurement. Iron was administered when ferritin was below 100 ng/mL or transferrin saturation below 20%.
Results
One-hundred and two patients were enrolled (61 men, 41 women; mean age 68.9 ± 12.5 years). There was no difference in baseline characteristics between the two groups. At end of study, mean Hb levels were not different between the new method group and standardized method group (10.5 ± 0.7 g/dL vs. 10.5 ± 0.7 g/dL, P = 0.936). The ratio of patients with Hb levels within target range were significantly different between the new and standardized method groups (75% vs. 50%, P = 0.021 by chi-square tests). Required EPO dose were not different between the new and standardized method groups (2578.1 ± 1851.2 IU/w vs 3046.9 ± 2627.3 IU/w, P = 0.359). There were no adverse events related to the new method.
Conclusion
The new method for EPO dosing is superior to existing standardized EPO dosing method.