Nocturnal Dialysis Decreases EPO Use

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Virginia program found to cut average billed dose per week by 40% compared with the national average.

 

ORLANDO—Patients receiving nocturnal hemodialysis may have lower erythropoietin (EPO) requirements than other dialysis patients, according to findings reported here at the 2008 Annual Dialysis Conference.

 

Robert S. Lockridge, Jr., MD, of Lynchburg Nephrology in Lynchburg, Va., and his colleagues examined EPO use by patients enrolled in the University of Virginia-Lynchburg Nightly Home Hemodialysis (NHHD) program. Their average billed EPO dose per week was decreased by 40% compared with national data on EPO use reported to the U.S. Renal Data System (USRDS) from January 1, 2004 to December 31, 2005 and reduced by 22% compared with the same patients prior to enrolled in the NHHD program, according to the investigators.

 

Sixty-one patients were trained to perform NHHD during the study period. Of these, six left the program. For the remaining 55 patients (mean age 55 years; 64% male; 58% white), researchers captured all EPO charges, which included the dose, for at least three months from September 1, 1997 to July 1, 2006. Of the 55 patients, one used no EPO during the NHHD period.

 

The mean follow-up of the 55 patients was 37 months (maximum, 101.6 months). There were a total of 170 patient years. Hemoglobin levels in all patients were measured monthly. The researchers also captured up to two years of EPO data for 46 of the patients prior to starting NHHD. Of the 46 patients, two used no EPO during the pre-NHHD period.

 

Dr. Lockridge's group defined NHHD as five or more hemodialysis treatments at home per week for at least five hours per treatment.

 

The average weekly billed EPO dose per patient was 10,592 units for those receiving NHHD group compared with 13,579 for patients while on dialysis prior to enrolling in the NHHD program. The U.S. average for dialysis patients, based on data reported to USRDS, was 17,753 units.

 

Additionally, the reduced EPO dose was associated with improved hemoglobin levels. The three-month average hemoglobin of patients during NHHD ranged from a low of 11.2 g/dL to a high of 13.2 g/dL, with a mean of 12.5 g/dL. The three-month average for patient before NHHD ranged from a low of 10.7 g/dL to a high of 11.6 g/dL, with a mean of 11.3 g/dL.

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