Hemoglobin Levels and Erythropoietin Doses in Hemodialysis and Peritoneal Dialysis Patients in the United States

Snyder, Jon J.; Foley, Robert N.; Gilbertson, David T.; Vonesh, Edward F.; Collins, Allan J.

doi:10.1097/01.asn.0000102475.94185.54

Cited by 58 publications

(46 citation statements)

References 23 publications

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“…First, data on dialysis adequacy, residual renal function, delivered dialysis dose, anemia management, and mineral metabolism parameters were not available. However, previous studies suggested that PD patients tend to have higher residual renal function over time (9,32), similar target hemoglobins (33), and inconsistent differences in nutritional parameters (17,34). These differences should bias toward the null hypothesis or toward improved outcomes in PD patients.…”

Section: Discussionmentioning

confidence: 99%

Mortality by Dialysis Modality among Patients Who Have End-Stage Renal Disease and Are Awaiting Renal Transplantation

Inrig

Sun

Yang

et al. 2006

Clinical Journal of the American Society of Nephrology

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Comparing outcomes related to dialysis modality is complicated by selection bias introduced by patients and physicians. To address the impact of selection bias, this study compared mortality by initial dialysis modality among patients who had ESRD and were placed on the transplant waiting list. This study was a historical prospective cohort of 12,568 patients in the United States who initiated dialysis between May 1, 1995, and October 31, 1998, and were placed on the transplant waiting list before dialysis initiation. Two-year mortality was compared using Kaplan-Meier curves and Cox proportional hazards models that analyzed patients primarily using an intention-to-treat approach and separately censored patients on a modality switch. At 2 yr, the unadjusted mortality rate was 6.6% among peritoneal dialysis (PD) patients compared with 6.9% among hemodialysis (HD) patients (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.82 to 1.23). After controlling for differences in baseline characteristics, comorbidities, and laboratory variables, the selection of PD versus HD remained associated with a similar 2-yr mortality risk (HR 1.03; 95% CI 0.83 to 1.28). In separate models, 2-yr mortality associated with PD versus HD was significant among patients with body mass index (BMI) >26 kg/m 2 (HR 1.37; 95% CI 1.01 to 1.83) but not among patients with BMI <26 kg/m 2 (HR 0.81; 95% CI 0.61 to 1.07). Results were similar after censoring on a modality switch. In conclusion, although choice of initial dialysis modality seems to be associated with equivalent outcomes among patients who have ESRD and are placed on the transplant waiting list, patients with BMI >26 kg/m 2 have increased 2-yr mortality associated with the selection of PD versus HD. Because the interpretation of observational data is highly affected by residual confounding and selection bias, further efforts should focus on the formation and testing of hypotheses to improve dialysis delivery.

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Section: Discussionmentioning

confidence: 99%

Mortality by Dialysis Modality among Patients Who Have End-Stage Renal Disease and Are Awaiting Renal Transplantation

Inrig

Sun

Yang

et al. 2006

Clinical Journal of the American Society of Nephrology

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“…First, only 25% of patients who started PD treatment between 1995 and 2000 were treated with ESAs in the first 12 months (10). In addition, the achieved hemoglobin in recent years is significantly higher than that in the 1990s (11).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the achieved hemoglobin in recent years is significantly higher than that in the 1990s (11). Third, ESAs are administered subcutaneously in PD patients in contrast to intravenous administration in hemodialysis patients, and hence, doses are lower (10). Fourth, ESA administration and achieved hemoglobin are substantially more dependent upon patient adherence for PD patients than among those treated with hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

Association of Hemoglobin and Survival in Peritoneal Dialysis Patients

Molnar

Mehrotra

Duong³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Interventional trials and some observational studies show target hemoglobin Ͼ13 g/dl to be associated with higher mortality in erythropoiesis-stimulating agent-treated (ESA-treated) hemodialysis patients; data for peritoneal dialysis (PD) patients are limited.Design, setting, participants, & measurements We tested our hypothesis that higher and lower achieved hemoglobin levels are associated with increased mortality in 9269 ESA-treated PD patients from all DaVita dialysis clinics during the time period

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“…14,15 Despite this, patients receiving peritoneal dialysis appear to require substantially lower doses of erythropoietin to control their anemia. 16,17 Possible reasons for this reduced epoetin dose requirement include a lower level of blood loss and inflammation in patients receiving peritoneal dialysis, the use of the subcutaneous route, as is usually the case in a peritoneal dialysis population, as well as improved dialytic removal of inhibitors of erythropoiesis. 16 Of interest in the present study, the mean dose of epoetin δ was numerically lower than the dose epoetin patients were receiving before entering the study.…”

Section: Resultsmentioning

confidence: 99%

“…Hematologic parameters were assessed weekly and the primary efficacy endpoint was the mean hemoglobin level over weeks [12][13][14][15][16][17][18][19][20][21][22][23][24]. Secondary endpoints included the mean treatment dose, mean hematocrit, and percentage of hemoglobin measurements >10 g/dL and hematocrit measurements >30%.…”

Section: Endpoints and Analysismentioning

confidence: 99%

Anemia management in patients on peritoneal dialysis: efficacy and safety of epoetin

Spinowitz¹

2008

Haematologica

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In a one-year, multicenter, open-label, uncontrolled trial, epoetin δ was given subcutaneously, 1-3-times weekly to peritoneal dialysis patients who had previously received an epoetin. Dose was adjusted to maintain hemoglobin at 10.0-12.0 g/dL. The primary endpoint was mean hemoglobin over weeks 12-24. Safety was assessed. Mean±SD baseline hemoglobin was 11.2±0.9 g/dL. Hemoglobin over weeks 12-24 was 11.6±1.1 g/dL. Adverse events were those expected in this patient population. No life-threatening adverse events occurred. Subcutaneous epoetin δ was effective and well tolerated for the treatment of anemia in peritoneal dialysis patients.

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Hemoglobin Levels and Erythropoietin Doses in Hemodialysis and Peritoneal Dialysis Patients in the United States

Abstract: Abstract. Erythropoietic agents, a cornerstone of management, are a major component of the cost of renal replacement therapy.

Cited by 58 publications

References 23 publications

Mortality by Dialysis Modality among Patients Who Have End-Stage Renal Disease and Are Awaiting Renal Transplantation

Mortality by Dialysis Modality among Patients Who Have End-Stage Renal Disease and Are Awaiting Renal Transplantation

Association of Hemoglobin and Survival in Peritoneal Dialysis Patients

Anemia management in patients on peritoneal dialysis: efficacy and safety of epoetin

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