Kidney Week

Abstract: SA-PO422

Association of Erythropoiesis-Stimulating Agent Dose and Cardiac Magnetic Resonance Imaging Parameters in Patients Undergoing Hemodialysis

Session Information

• Hemodialysis and Frequent Dialysis - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Lefranc Torres, Armida, Brigham and Women's Hospital, Boston, Massachusetts, United States

Armida Lefranc Torres, MD

• Chertow, Glenn M., Stanford University School of Medicine, Stanford, California, United States

Glenn M. Chertow, MD, MPH, FASN

• McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Finnian R. McCausland, MBChB, MS, FASN

Background

Erythropoiesis-stimulating agents (ESAs) are commonly prescribed to patients on hemodialysis (HD) to treat anemia; however, ESA use to target higher vs. lower hemoglobin has been linked with adverse cardiovascular (CV) outcomes. Using data from the Frequent Hemodialysis Network (FHN) Daily Trial, we explored the association of ESA dose with MRI metrics of cardiac structure and function.

Methods

Among patients with available baseline and 12-month MRIs (n=184), random effects linear regression models were fit to explore the association of mean weekly ESA dose (≤5000, >5000-≤20000, >20000 EPO equivalent units) with cardiac MRI parameters on a per-visit basis, including left ventricular (LV) and right ventricular (RV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), LV mass (LVM), and LV mass index (LVMI). Models were adjusted for age, sex, designated race, BMI, randomized treatment, access, pre-HD systolic BP, heart failure, diabetes, hypertension, residual urea clearance (0, ≤1, >1 to 3, >3 ml/min), ultrafiltration rate, ACE inhibitor or ARB use, hemoglobin, phosphate, dialysis vintage (<2, 2-5, >5 years), and eKt/V_urea.

Results

In adjusted models, compared with an ESA dose of ≤5000 U per week, the highest category was significantly associated with 12.7 (95%CI 2.2, 23.1) g higher LVM, 6.6 (95%CI 1.1, 12.0) g/m2 higher LVMI, 8.4 (95%CI 0.0, 16.8) mL higher LVSV, and 13.7 (95%CI 0.8, 26.6) mL higher LVEDV. No significant differences were observed with LVESV, LVEF, or any of the RV parameters (Table 1).

Conclusion

After adjusting for an array of potential confounders, higher mean weekly ESA dose was associated with significantly higher LVM, LVMI, LVEDV, and LVSV in patients receiving conventional and frequent HD. Future studies are needed to identify the mechanism(s) responsible for these associations and whether these findings, if directly related to ESAs, can be ameliorated or reversed.

Funding

• NIDDK Support