Kidney Week

Abstract: FR-PO397

Association of Risk of Death and Hemoglobin (hgb) Variability in Anemia Management of Patients on Hemodialysis

Session Information

• Hemodialysis Epidemiology and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Mermelstein, Ariella E., Renal Research Institute, New York, New York, United States

Ariella E. Mermelstein, MA

• Kovacevic, Tomislav, Vifor Fresenius Medical Care Renal Pharma Ltd, St Gallen, St Gallen, Switzerland

Tomislav Kovacevic, MD

• Wang, Yuedong, University of California Santa Barbara, Santa Barbara, California, United States

Yuedong Wang, PhD

• Fuertinger, Doris H., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Doris H. Fuertinger, PhD

• Hymes, Jeffrey L., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Jeffrey L. Hymes, MD

• Raimann, Jochen G., Renal Research Institute, New York, New York, United States

Jochen G. Raimann, MD, PhD, MPH

• Kotanko, Peter, Renal Research Institute, New York, New York, United States

Peter Kotanko, MD, FASN

Background

The current target hgb range for US HD patients treated with erythropoietin-stimulating agents (ESAs) for anemia, is between 10 and 11 g/dL. Earlier retrospective studies show lower mortality rates when hgb was within a range of 10.2 to 12.4 g/dL. This wider range was more favorable independent of hgb variability over time. For the current analysis we studied hgb variability in different strata of cumulatively administered long-acting ESA (Mircera).

Methods

We defined the baseline period as 6 months from the first ESA dose which had to be administered within 90 days of HD initiation. We calculated patient-specific mean baseline hgb. We fit a linear regression model to calculate the variance of the residuals. We stratified the patient cohort as per the cumulative sum of administered baseline ESA doses (50 to 465, 466 to 700, 701 to 1075, and 1076 to 5050 mcg) and built 4 Cox proportional hazard models of mortality risk over the 18-month follow-up period. Models were adjusted for age, sex, race, diabetes, serum albumin, and phosphorus.

Results

We studied 62,181 HD patients (63.4 years, 57.2% male, 38.8% diabetic, mean baseline hgb 10.42 ± 0.72 g/dL). While a wider and higher range of hgb seems to confer a survival advantage, differences in the patterns in the association between risk of death and hgb are seen at different levels of administered ESA, suggesting variability to increase the risk of death with higher cumulatively administered ESA doses.

Conclusion

Current US guidelines indicate hgb target range of 10 to 11 g/dL when treated with ESAs. Our retrospective research identified a wider and higher hgb range to be associated with lower mortality rates independent of variability. Based on the bivariate investigation, increased variability seems to confer a more accentuated risk increase at higher cumulative ESA doses. In-depth investigation in the underlying pathophysiological dynamics of hgb variability is imperative.

Funding

• Commercial Support – Vifor Fresenius Medical Care Pharma Ltd