Nadir hemoglobin levels after discontinuation of epoetin in hemodialysis patients.

Clinical Journal of the American Society of Nephrology : CJASN
Jose A CalvoDaniel E Weiner

Abstract

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. 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 > or = 13 g/dl were evaluated. The primary outcome was nadir hemoglobin within 2 months of epoetin reduction or discontinuation. There were 2789 patients in whom epoetin was discontinued and 754 patients in whom epoetin was reduced after hemoglobin > or = 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...Continue Reading

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Feb 27, 2013·Nature Reviews. Nephrology·Walter H Hörl

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