Kidney Week

Abstract: TH-PO955

Hemoglobin Variability in Hemodialysis Patients Improves Under Individualized Anemia Therapy

Session Information

• Anemia in CKD: Risk Factors, Practice Patterns, Therapies
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

• 200 Anemia and Iron Metabolism

Authors

• Fuertinger, Doris H., Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

Doris H. Fuertinger,

• Joerg, David J., Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany

David J. Joerg,

• Ho, Kevin, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Kevin Ho,

• Wang, Lin-Chun, Renal Research Institute, New York, New York, United States

Lin-Chun Wang,

• Tisdale, Lela, Renal Research Institute, New York, New York, United States

Lela Tisdale,

• Ye, Xiaoling, Renal Research Institute, New York, New York, United States

Xiaoling Ye,

• Thijssen, Stephan, Renal Research Institute, New York, New York, United States

Stephan Thijssen,

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko,

Background

Anemia is a common complication in patients receiving hemodialysis. Anemia treatment with erythropoiesis-stimulating agents (ESAs) is challenging and Hgb outcomes vary widely in clinical practice. In a randomized controlled clinical trial (RCT), we investigated the impact of an individualized anemia therapy tool on hemoglobin (Hgb) variability.

Methods

Patients were randomized 1:1 to be treated with an individualized ESA dose recommendation tool (intervention (INT) group) or an anemia management protocol (standard of care (SoC) group) for 26 weeks; 82 patients completed the study (INT: N=40, SoC: N=42). The recommendation tool utilized a previously validated physiology-based model of anemia to estimate key patient-specific physiological characteristics, such as red blood cell lifespan, to create a digital twin from recent routine clinical data (Fuertinger et al., PLOS ONE 13(4):e0195918, 2018). Based on the patient’s digital twin, individual ESA dose recommendations for methoxy polyethylene glycol-epoetin beta were generated to target a Hgb window of 10-11 g/dL.

Results

Interpatient variation in mean Hb levels over the study period was smaller in the INT group than in the SoC group (Variance 0.15 vs 0.66 g²/dL² , F-test, p<0.001) while the mean shifted to the center of the target range (10.5 vs 10.8 g/dl). The distributions of mean monthly Hgb levels progressively narrowed in the INT group over time (see Fig. 1, left panel). Further, intrapatient Hgb variability, defined as the standard deviation around the mean Hgb levels, improved in the INT group compared to the SoC group (median [IQR]: 0.7 [0.3] vs 0.9 [0.6] g/dL, Wilcoxon-rank sum test, p=0.001) (see Fig 1, right panel).

Conclusion

The RCT results suggest that the individual ESA recommendations of the anemia therapy tool improves inter- and intrapatient Hgb variability, while also bringing mean Hgb levels into the desired target range.

Funding

• Commercial Support – Fresenius Medical Care