Abstract: FR-PO0236
Erythropoiesis-Stimulating Agent (ESA) Dosage and Erythropoietin Resistance in Patients on ESAs Undergoing Hemodialysis vs. Hemodiafiltration: A Multinational European Cohort Study
Session Information
- Anemia and Iron Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Rigodon, Vladimir, Renal Research Institute, LLC, New York, New York, United States
- Van Zandt, Carly R., Renal Research Institute, LLC, New York, New York, United States
- Ficociello, Linda, Renal Research Institute, LLC, New York, New York, United States
- Usvyat, Len A., Renal Research Institute, LLC, New York, New York, United States
- Stuard, Stefano, Fresenius Medical Care Italia S.p.A., Palazzo Pignano, Cremona, Italy
Background
ESA requirements may increase with inflammation in chronic dialysis patients. Hemodialfiltration (HDF) provides better clearance of middle and large molecules than hemodialysis (HD) and may result in less systemic inflammation for dialysis patients. Thus we aimed to examine ESA doses and erythropoietin resistance index (ERI) in HDF and HD patients on ESAs in a contemporary real-world setting, while adjusting for achieved hemoglobin, anemia markers and IV iron dose.
Methods
Data was extracted from the global anonymized dialysis database, Apollo Dial DB. We analyzed a European cohort of 12,432 adult HD and HDF patients with ≥6 months dialysis vintage. Patients were required to have 6 months of ESA doses, monthly hemoglobin, and weight data. ERI, defined as the weekly weight-adjusted ESA dose per hemoglobin unit (IU/kg/week per g/dL), reflects the responsiveness to ESA therapy.1 Weekly ERI was calculated and averaged over 6 months. Generalized linear models (SAS 9.4) estimated adjusted least-squares means.
Results
Our final cohort was 57% male, and 40% were between the ages of 45-64. The 6-month mean epoetin dose was 98,950 IU. Mean ESA dose and ERI for HD (n=5,735) and HDF (n=6,697) groups are presented in Table 1. After full adjustment for covariates, we observed 413 IU/week less ESA (p<0.0001) and 0.81 lower ERI comparing HDF to HD (p<0.0001).
Conclusion
In this large real-world cohort, HDF was associated with lower ESA requirements and improved ESA responsiveness compared to conventional HD, even after adjustment for anemia and iron markers, IV iron, and demographic variables. These findings suggest more efficient anemia management with HDF when compared to HD.
Funding
- Commercial Support – Fresenius Medical Care