Mortality in dialysis patients may not be associated with ESA dose: a 2-year prospective observational study
Web of Science
AuthorMcMahon, LP; Cai, MX; Baweja, S; Holt, SG; Kent, AB; Perkovic, V; Leikis, MJ; Becker, GJ
Source TitleBMC Nephrology
University of Melbourne Author/sBECKER, GAVIN; LEIKIS, MURRAY; PERKOVIC, VLADO; Holt, Stephen; Cai, Michael
AffiliationClinical School (Royal Melbourne Hospital)
Document TypeJournal Article
CitationsMcMahon, L. P., Cai, M. X., Baweja, S., Holt, S. G., Kent, A. B., Perkovic, V., Leikis, M. J. & Becker, G. J. (2012). Mortality in dialysis patients may not be associated with ESA dose: a 2-year prospective observational study. BMC NEPHROLOGY, 13 (1), https://doi.org/10.1186/1471-2369-13-40.
Access StatusOpen Access
BACKGROUND: Anaemia of chronic kidney disease increases the risk of death and adverse events, but can be managed using erythropoiesis stimulating agents (ESAs). However, recent evidence suggests that targeting a higher haemoglobin concentration ([Hb]) increases mortality risk, and both higher [Hb] targets and ESA doses have been implicated. Nonetheless, a causative role has not been demonstrated, and this potential relationship requires further appraisal in such a complex patient group. METHODS: The relationship between the haematopoietic response to ESAs and patient survival in 302 stable, prevalent dialysis patients was explored in a prospective, single-centre study. Clinical and laboratory parameters influencing mortality and ESA resistance were analysed. Patients were stratified into 5 groups, according to their [Hb] and ESA dosage, and were followed for 2 years. RESULTS: Little difference in co-morbidities between groups was identified. 73 patients died and 36 were transplanted. Initial analysis suggested a direct relationship between mortality and ESA dosage. However, Cox proportional hazards multivariate analysis demonstrated mortality risk was associated only with age (adjusted HR per year: 1.061, 95% CI 1.031-1.092), dialysis duration (adjusted HR: 1.010, 95% CI 1.004-1.016), peripheral vascular disease (adjusted HR: 1.967, 95% CI 1.083-3.576) and CRP (adjusted HR: 1.024, 95% CI 1.011-1.039). Mortality was increased in patients poorly responsive to ESAs (55.5%). CONCLUSION: ESA dose does not appear to contribute substantially to mortality risk in dialysis patients. Instead, age and co-morbidities appear to be the critical determinants. A poor response to ESAs is a marker of overall poor health status.
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