Nadir Hemoglobin Levels after Discontinuation of Epoetin in Hemodialysis Patients

Abstract

Background and objectives: In hemodialysis patients, both hemoglobin variability and targeting normalization of hemoglobin may have adverse consequences. There are few data on epoetin management in patients achieving high hemoglobin levels.Design, setting, participants, & measurements: Maintenance hemodialysis patients within Dialysis Clinic Inc. (DCI) who were treated with a 20 to 30% epoetin dose reduction versus epoetin discontinuation following achievement of a hemoglobin level of >13 g/dl were evaluated. The primary outcome was nadir hemoglobin within 2 months of epoetin reduction or discontinuation.Results: There were 2789 patients in whom epoetin was discontinued and 754 patients in whom epoetin was reduced after hemoglobin >13 g/dl. Patients treated with reduction received significantly more epoetin over the subsequent 2 months. More patients dropped below 11 (21.5 versus 10.1%) and 10 g/dl (7.2 versus 3.6%) within 2 months of discontinuing epoetin, whereas reduction was associated with more frequent nadir hemoglobin levels >12 g/dl (31.1 versus 62.8%). In multivariable models including age, ferritin, albumin, and baseline epoetin dose, discontinuation was associated with nadir hemoglobin below 10 g/dl [OR ‫؍‬ 1.91 (CI: 1.22, 2.99)], whereas reduction was associated with a hemoglobin nadir above 12 g/dl [OR ‫؍‬ 4.41 (CI: 3.63, 5.37)].Conclusions: In hemodialysis patients with baseline hemoglobin >13 g/dl, epoetin discontinuation is associated with lower epoetin use and a higher probability of reaching a hemoglobin target range of 10 to 12 g/dl within 2 months; discontinuation is also associated with a higher likelihood nadir hemoglobin <10 g/dl.

Prospective study on blood pressure, lipid metabolism and erythrocytosis during and after androgen abuse

“…The rate of recovery then depends on factors such as intermediate enzymes, hormones and cells, e.g. erythropoietin and red blood cells for haematocrit (Calvo et al, 2010).…”

Briefly Noted

“…A retrospective study of epoietin reduction for hemoglobin levels ≥13 gm/dl assessed the nadir hemoglobin 2 months after either stopping the ESA ( N = 2789) or reducing it by 20–30% ( N = 754) (1). A nadir hemoglobin within the target of 10–12 gm/dl was reached in 62% of the discontinuation group compared with 34% in the dose reduction group.…”