ESA Resistance Increases Death Risk More in HD than PD Patients

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PHILADELPHIA—Most patients on peritoneal dialysis (PD) receive substantially lower doses of erythropoiesis stimulating agents (ESAs) for the same achieved hemoglobin levels compared with patients on hemodialysis (HD), investigators reported at Kidney Week 2011.

In addition, the study, by Uyen Duong, MD, of the Harbor-UCLA Medical Center in Torrance, Calif., showed that ESA resistance is associated with higher mortality for HD than for PD patients.

The findings, from a study of 139,103 HD and 10,527 PD patients treated from July 2001 through June 2006, are consistent with the known selection bias for PD patients, who have a lower comorbidity burden.

In the PD cohort, the adjusted risk of all-cause mortality declined by 3% and 15% for patients who received ESA doses of 3,000-5,999 and 6,000-8,999 U/week, respectively, compared with those with ESA doses below 9,000 U/week. The risk increased by 8% for patients who received ESA doses of 9,000 U/week or higher.

In the HD cohort, the risk increased by 14%, 54%, and twofold among patients who received ESA doses of 10,000-19,999, 20,000-29,999, and 30,000 U/week or higher, respectively.

PD and HD patients in the fourth quartile of ESA resistance index (ESA dose/hemoglobin level) had an adjusted 14% and 2.3-fold increased risk of death from any cause compared with their counterparts in the first quartile.

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