Abstract: SA-PO1017
Does Erythrocyte Stimulating Agent (ESA) Exposure Contribute to the Obesity Paradox?
Session Information
- Hemodialysis and Frequent Dialysis - VI
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- 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
Background
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.
Methods
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.
Results
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.
Conclusion
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
| Facility | ESA Cost/Treatment ($) | Average Patient Weight (kg) | ESA Cost/Treatment/kg ($/kg) |
| 1 | 17.47 | 72.5 | 0.24 |
| 2 | 18.30 | 75.3 | 0.24 |
| 3 | 27.28 | 80.0 | 0.34 |
| 4 | 22.72 | 75.3 | 0.30 |
| 5 | 23.86 | 77.8 | 0.31 |
| 6 | 20.37 | 79.4 | 0.26 |
| 7 | 19.68 | 79.3 | 0.25 |
| Average | 21.38 | 77.1 | 0.28 |
ESA exposure by BMI
hgb by BMI
Funding
- Clinical Revenue Support