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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Kidney Week

Abstract: SA-PO1017

Does Erythrocyte Stimulating Agent (ESA) Exposure Contribute to the Obesity Paradox?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Silberzweig, Jeffrey I., The Rogosin Institute, New York, New York, United States
  • Parker, Thomas, The Rogosin Institute, New York, New York, United States
  • Kim, Kwan, The Rogosin Institute, New York, New York, United States
  • Levine, Daniel M., The Rogosin Institute, New York, New York, United States

Group or Team Name

  • The Governing Body of The Rogosin Institute

Epidemiologic and retrospective data document a survival advantage for obese (BMI > 30 kg/m2) patients treated by maintenance hemodialysis (HD). Prospective data suggest that higher ESA doses are associated with adverse clinical outcomes.


Our quality program reviews the proportion of patients with hemoglobin (hgb) between 10-11.5 g/dL and ESA dosing and costs. We sought to understand variations by comparing ESA requirements based on BMI.


The facliity with the lowest average patient weight has the lowest average ESA cost (See table). ESA exposure decreased as BMI increased (p<0.0001). Hgb levels did not vary with BMI. (See figures.) There is a trend towards longer survival among obese patients.


ESA exposure varies with BMI in our patient population; hgb does not. ESA costs and doses vary with BMI. We hypothesize that lower ESA exposure contributes to improved survival among obese patients with CKD treated by HD.

Impact of Weight on ESA Cost per Treatment Q1 2019
FacilityESA Cost/Treatment ($)Average Patient Weight (kg)ESA Cost/Treatment/kg ($/kg)

ESA exposure by BMI

hgb by BMI


  • Clinical Revenue Support