Use of red blood cell transfusion (RBCT) to treat anemia in patients receiving dialysis increases with persistent hyporesponse to erythropoiesis-stimulating agents (ESA), according to study data presented at the National Kidney Foundation’s 2023 Spring Clinical Meetings in Austin, Texas.

The mean number of days with RBCTs was higher for patients with persistent ESA hyporesponsiveness (60% of months or more) than for those with acute hyporesponsiveness (less than 60% of months): 3.3, 2.1, and 2.8 days for those receiving hemodialysis, peritoneal dialysis, and a combination of these modalities, respectively, compared with 1.1, 0.7, and 1.5 days, respectively.

Among patients not experiencing hyporesponse to ESAs, the mean number of days with RBCTs was 0.3, 0.3, and 0.6 days, study investigators Christine Ferro, a consultant with Milliman, Inc., in New York, New York, and colleagues reported in a poster presentation.

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“These findings suggest that patients with hyporesponse incur costly healthcare utilization, and anemia treatment alternatives are needed,” the investigators concluded.

The study included 206,670 patients receiving dialysis, of whom 21,302 (10.3%) met the definition for hyporesponse to ESAs: 2 or more consecutive months in which the mean ESA weekly dose was higher than 300 epoetin alfa units/kg of body weight and a hemoglobin level in the prior month was lower than 10 g/dL. Of the 21,302 patients, 3554 (16.7%) had persistent hyporesponsiveness.

Patients receiving peritoneal dialysis only had the lowest rate of ESA hyporesponse compared with those receiving hemodialysis only and both modalities (8.4% vs 10.3% and 14.1%, respectively). Patients receiving peritoneal dialysis only had the higher rate of kidney transplantation regardless of hyporesponse.

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. Blood transfusion and transplant rates among Medicare patients with dialysis-dependent CKD and hyporesponse to ESAs. Presented at: NKF 2023 Spring Clinical Meetings, April 11-15, Austin, Texas. Poster 180.