Abstract: FR-PO0211
Trajectory of Anemia and Erythropoiesis-Stimulating Agent Use in ESKD During and After Hospitalization
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
- Vosters, Patrick, University of Iowa Health Care, Iowa City, Iowa, United States
- Swee, Melissa L., University of Iowa Health Care, Iowa City, Iowa, United States
- Yamada, Masaaki, University of Iowa Health Care, Iowa City, Iowa, United States
- Jalal, Diana I., University of Iowa Health Care, Iowa City, Iowa, United States
- Griffin, Benjamin R., University of Iowa Health Care, Iowa City, Iowa, United States
Background
Anemia, a prevalent complication of end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular disease, hospitalization, and mortality. Anemia is often exacerbated during hospital admission due in part to suboptimal administration of erythropoiesis stimulation agents (ESAs). Here, we evaluated ESA usage during and after admission and trends of hemoglobin recovery after discharge in patients with ESKD.
Methods
University of Iowa Heath Care hemodialysis patients with hospital admission from 2019-2024 were screened. Frequent, prolonged, or brief admissions were excluded. Hemoglobin values on admission, discharge, and monthly following discharge were extracted from the electronic health record in addition to ESA dosing and administration pre, during, and post admission. The primary outcome was time to goal hemoglobin of ≥10 g/dL after discharge. Secondary outcomes included rates of missed ESA doses and ESA dose adjustments after discharge.
Results
Of 315 outpatient hemodialysis patients identified, 66 have been screened to date, and 26 eligible admissions were analyzed. The comorbidity burden was high, with diabetes present in half of patients and congestive heart failure in over one third. Upon discharge, only 38% had hemoglobin levels ≥ 10 g/dL. Prior to admission, 73% of patients were on ESAs. Of these, only 37% received a dose during admission. In patients not at hemoglobin ≥ 10 g/dL at discharge, only 31% had their ESA dose increased as an outpatient in the month following admission, and the average time to reaching hemoglobin ≥10 g/dL following discharge was 71 (interquartile range 40-103) days.
Conclusion
In our large, academic center, ESA therapy is often missed during admissions and is not often adjusted afterwards, leading to suboptimal hemoglobin levels and delayed recovery of anemia. Interventions designed to optimize anemia management during and after hospital admission are needed.