Mortality in hemodialysis (HD) patients can be influenced by their responsiveness to erythropoiesis-stimulating agents (ESAs), according to Japanese researchers.

Shingo Fukuma, MD, and colleagues at Kyoto University studied 95,460 adult HD patients treated with ESAs. They defined six categories of ESA responsiveness based on a combination of ESA dosage (low [less than 6,000 U/wk] and high dosage [6,000 U/wk or greater]) and hemoglobin (Hb) level (low [less than 10 g/L], medium [10-11.9 g/dL], or high [12 g/dL or greater]). Medium Hb level and low-dose ESA therapy served as the reference category.

The researchers used the median ESA dosage (4,500-5,999 U/wk) as a cutoff point. The cohort had a mean Hb level of 10.1 g/dL. During follow-up, 7,205 patients (7.5%) died, including 5,586 (5.9%) cardiovascular deaths. Low hemoglobin levels and high-dose ESA therapy were both associated with all-cause mortality, the researchers reported in the American Journal of Kidney Diseases (published online ahead of print).

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In adjusted analyses, a low Hb level with low-dose ESA was associated with an 18% increased mortality risk. A medium Hb level with high-dose ESA was associated with a 44% increased risk. High-dose ESA with low Hb level (hyporesponsiveness) was associated with a twofold increased risk of death from any cause and from cardiovascular causes.

“Response category has prognostic importance and clinical relevance in anemia management,” the authors concluded.