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Kidney Week

Abstract: PO0055

Erythropoiesis-Stimulating Agents in AKI Requiring Dialysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Mccoy, Ian, Stanford University School of Medicine, Palo Alto, California, United States
  • Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background

Erythropoiesis-stimulating agents (ESAs) are used in patients with CKD to treat anemia. AKI may also be a state of erythropoietin deficiency, although data on this is conflicting. Few studies have examined ESA use in AKI, including the most severe AKI cases requiring dialysis (AKI-D). It is unknown whether and to what extent clinicians prescribe ESAs in AKI-D.

Methods

Among the more than 40,000 patients admitted to Beth Israel Deaconess Medical Center ICUs between 2001 and 2012 in the MIMIC-III database, we selected 591 AKI-D patients and 276 ESKD patients based on ICD-9 diagnostic codes. In a cross-sectional analysis, we determined the frequency of ESA usage and estimated associations between ESA usage and age, sex, surgical (vs medical) ICU admission, ICU length of stay, admission hemoglobin, admission serum creatinine, history of CKD, and ESKD (versus AKI-D) status using multivariable logistic regression. We also examined the relationship between ESA use and the number of blood transfusions during the ICU stay.

Results

ESA usage (any time during ICU stay) was 13% in AKI-D (vs 21% in ESKD). Among AKI-D patients (Table 1), CKD (adjusted OR 3.59, 95% CI 2.06-6.25, p<0.0001), length of stay (1.06 [1.04-1.08] per day, p<0.0001), sepsis (2.06 [1.08-3.92], p=0.03), and female sex (0.56 [0.31-1.00], p=0.05) were significantly associated with ESA use. Patients treated with ESAs received six more blood transfusions on average than patients who were not treated with ESAs (6.1 more transfusions, 95% CI 2.6-9.7, p=0.0006), but this difference disappeared when adjusted for the variables significantly associated with ESA usage (0.07 more transfusions, 95% CI -3.4 to +3.2, p=0.97).

Conclusion

ESAs usage in patients with AKI-D was not rare. Baseline renal function was the biggest predictor of ESA usage. Use of this costly therapy of unclear risk-benefit ratio in the AKI-D population should be studied further.

Patients with AKI-D
CharacteristicsESA
(n = 74)
No ESA
(n = 517)
Age, yrs62 (16)62 (15)
Female27%38%
Baseline chronic kidney disease45%23%
Admission serum creatinine, mg/dL3.1 (2.1)2.8 (2.4)
Admission hemoglobin, g/dL10.8 (2.1)11.3 (2.3)
Surgical ICU45%39%
Sepsis during ICU day 177%70%
ICU LOS, days28 (25)13 (12)
Blood transfusions during ICU stay15 (21)9 (13)

Funding

  • NIDDK Support