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Abstract: TH-PO299

Association of Erythropoiesis-Stimulating Agents with Peri-Dialytic Blood Pressure Parameters

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Singh, Anika T., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Yen, Timothy E., The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Sarvode Mothi, Suraj, St Jude Children's Research Hospital, Memphis, Tennessee, United States
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Anemia is a common comorbid condition among patients with end-stage kidney disease (ESKD) requiring maintenance hemodialysis and is associated with morbidity and mortality. While recombinant human erythropoietin (rHuEPO) revolutionized anemia correction, concerns existed about the development or worsening of hypertension. This study aims to understand practice patterns of erythropoiesis-stimulating agent (ESA) use in outpatient hemodialysis and associations of ESA use with Hyper0 (any increase in systolic BP from pre- to post-HD) and peri-HD BP parameters.


ESA administration at individual HD sessions was assessed from the DaVita Biorepository (n=950), a prospective cohort study consisting of clinical data and biospecimen collection. Unadjusted and multivariable Poisson and linear random effects models adjusted for age, sex, race, access, pre-HD SBP, HD vintage, UFR, diabetes, heart failure, ischemic heart disease, peripheral vascular disease, and lung disease were fit. Exploratory models were fit including the prior variables with additional adjustment for hemoglobin (Hb) and endothelin-1 (ET-1).


Mean age was 53 ±22 years, 44% were females, and 38% were Black. Mean pre-HD SBP was 152 ±28 mmHg. ESAs were administered at 97,172 of the 135,892 sessions (71.5%) sessions. Those with ESAs administered were younger, had higher UF volume and rate, longer HD sessions, higher pre-HD SBP, diabetes, PVD, and higher Hb and ET-1. In fully adjusted models, we observed a 9% higher rate of Hyper0 (IRR 1.09; 95%CI 1.06–1.12 mmHg.) In exploratory models adjusted for Hb + ET-1, this association was mildly attenuated (IRR 1.06; 95%CI 1.01–1.1 mmHg.) In fully adjusted models of peri-HD parameters, ESAs were associated with a higher nadir SBP (IRR 1.3; 95%CI 1.1–1.6 mmHg) with similar patterns of association noted for ESAs and post-HD SBP.


We observed an independent association between ESA administration and higher risk of Hyper0, and higher intradialytic SBP parameters. Future studies are warranted to better understand the mechanisms underlying these findings.


  • NIDDK Support