Erythropoiesis-Stimulating Agents on Trial: Are Higher Dosages Causing Harm?

Chaknos, C. Michael; Berns, Jeffrey S.

doi:10.1053/j.ajkd.2012.10.004

Cited by 5 publications

(1 citation statement)

References 13 publications

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“…Aside from the cost benefit, the need for a lower ESA dose with ultrapure dialysate may also have a favorable impact on clinical outcomes. The ESA dose is thought to be an important contributor to the increased cardiovascular risk observed in the high hemoglobin target groups of ESA clinical trials . A comprehensive meta‐regression analysis of 31 studies involving more than 12,000 participants examining the association of ESA dose with adverse outcomes found that the higher ESA dose was associated with higher mortality, stroke, thrombotic events, and dialysis vascular access‐related complications independent of the achieved hemoglobin level .…”

Section: Discussionmentioning

confidence: 99%

Ultrapure versus standard dialysate: A cost‐benefit analysis

Upadhyay

Susantitaphong

Jaber

2017

Seminars in Dialysis

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Low-level bacterial and endotoxin contamination of water used to generate dialysate propagates chronic inflammation in patients with a wide-range of potential adverse consequences, including erythropoietin hyporesponsiveness. Advancements in hemodialysis systems now allow for the generation of ultrapure dialysate that has lower bacterial and endotoxin levels than the standard dialysate. The cost associated with ultrapure dialysate is thought to be a major barrier to its widespread adoption. In this report, we conduct a cost-benefit analysis examining the excess cost of generating ultrapure dialysate and the potential cost saving from a lower erythropoietin dose requirement. Our analysis suggests a potential cost saving of approximately $371 to $425 million per year with full adoption of ultrapure dialysate in the United States.

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Section: Discussionmentioning

confidence: 99%

Ultrapure versus standard dialysate: A cost‐benefit analysis

Upadhyay

Susantitaphong

Jaber

2017

Seminars in Dialysis

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Management of anemia with erythropoietic-stimulating agents in children with chronic kidney disease

Warady

Silverstein

2013

Pediatr Nephrol

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Anemia management is an important component of the care provided to children with chronic kidney disease (CKD) and influences both morbidity and mortality risk. The introduction of recombinant human erythropoietin to the treatment regimen three decades ago revolutionized the therapy and significantly decreased the need for repeated blood transfusions and exposure to associated risks. Recent data on the efficacy and complications associated with erythropoietic-stimulating agent (ESA) usage has, however, prompted a reassessment of treatment-related recommendations. This review will address these recommendations, in addition to describing pediatric outcomes associated with current ESAs and presenting information on alternative ESAs, many of which will likely soon be incorporated into clinical practice.

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