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Abstract: TH-PO666

Prevalence of Hyporesponse to Erythropoiesis-Stimulating Agents Among Medicare Patients With CKD-Related Anemia According to Absolute or Weight-Based Definitions

Session Information

  • Anemia and Iron Metabolism
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Berner, Todd, Akebia Therapeutics Inc, Cambridge, Massachusetts, United States
  • Ferro, Christine, Milliman USA, New York, New York, United States
  • Dieguez, Gabriela, Milliman USA, New York, New York, United States
  • Metz, Steve, Milliman USA, New York, New York, United States
  • Benjumea, Darrin W., Genesis Research LLC, Hoboken, New Jersey, United States
  • Johansen, Kirsten L., Hennepin Healthcare, Minneapolis, Minnesota, United States

Erythropoiesis-stimulating agents (ESAs) are widely used to treat anemia of chronic kidney disease (CKD). ESA hyporesponsiveness is associated with adverse events, leading to higher healthcare resource utilization. Hyporesponse (HR) has been defined vaguely as need for high doses of ESAs with or without achieving target hemoglobin levels. No standard definition of HR exists, and terms offered in literature vary widely. Using data representing 100% of Medicare fee-for-service beneficiaries, we examined the prevalence of hyporesponsiveness using different definitions in a dialysis-dependent (DD)-CKD patient population in the US.


We identified patients with DD-CKD receiving 3+ months of outpatient dialysis (in-center or at home) with concurrent ESA use in 2019. For each patient, we defined months of HR as those where the hemoglobin level for the prior month was <10 g/dL and the current month’s average ESA weekly dose surpassed weight dependent and weight agnostic thresholds: 300 epoetin alfa (epo) units (U)/kg of body weight, 375U/kg, 450U/kg, and 18,000U. We assessed the number and percent of patients at least one month of HR or with at least 60% of months of HR.


We identified 247,992 patients with DD-CKD and 3+ months of ESA use. Table 1 presents the number of patients and prevalence of HR by average weekly ESA dose threshold.


Different definitions of ESA hyporesponse among people with CKD-related anemia produced a range of prevalence rates. In our study, between 7.0% and 31.2% of patients experienced at least one month of HR; however, only a fraction of these (0.4% to 3.0%) were hyporesponsive for at least 60% of the time, reflective of the transient nature of the condition. Further research is needed to understand the clinical trajectories of episodically hyporesponsive patients.


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