Hyporesponse to erythropoiesis-stimulating agents (ESAs) is associated with higher rates of hospital admission, readmission, and early death among patients receiving dialysis, investigators reported at the National Kidney Foundation’s 2023 Spring Clinical Meetings in Austin, Texas.

Among 206,670 Medicare beneficiaries on dialysis treated with ESAs (eg, epoetin alfa, epoetin beta, or darbepoetin alfa), 21,302 patients (10.3%) had hyporesponse, defined as a hemoglobin level less than 10 g/dL in the prior month despite receipt of more than 300 epoetin alfa-equivalent units per kg each week. Among ESA hyporesponders, 83.3% had acute hyporesponse and 16.7% had persistent hyporesponse, defined as meeting criteria less than or more than 60% of months, respectively.

The rate of ESA hyporesponse was highest among patients receiving both hemodialysis and peritoneal dialysis (14.1%), followed by hemodialysis only (10.3%), and peritoneal dialysis only (8.4%).

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Hospital admission rates were higher among persistent hyporesponders (mean 3.3, 2.9, 1.7 admissions per person per year [PPPY]) and acute hyporesponders (3.2, 2.3, and 1.6 PPPY), compared with patients without hyporesponse (2.1, 1.2, and 1.0 PPPY) in the groups receiving both dialysis modalities, hemodialysis only, and peritoneal dialysis only, respectively, Kirsten Johansen, MD, of Hennepin Healthcare in San Francisco, California, and colleagues reported. Rates of readmission within 30 days followed the same pattern. Among patients receiving hemodialysis, for example, acute and persistent ESA hyporesponders experienced 0.2 and 0.3 readmissions, respectively, compared with 0.1 readmissions among patients without hyporesponse.

Mortality rates in the year 2019 were higher among persistent (10.0%-23.9%) and acute hyporesponders (8.8%-12.9%), compared with patients who had no hyporesponse (6.1%-8.0%), across dialysis modalities.

“Patients with ESA hyporesponse use more healthcare resources and have worse outcomes and higher mortality than patients who respond to ESA treatment,” Dr Johansen’s team highlighted. “These findings suggest that alternative anemia therapies are needed.”

Disclosure: This research was supported by Akebia. Please see the original reference for a full list of disclosures.


Ferro C, Benjumea D, Dieguez G, Metz S, Harrigan K, Johansen KL. Inpatient admission and mortality rates among Medicare patients with dialysis-dependent CKD and hyporesponse to ESAs. Presented at: NKF 2023, Austin, Texas, April 11-15. Abstract 179.