Predialysis Anemia Treatment May Cut Mortality After HD Initiation
HD patients with untreated or ineffectively treated anemia prior to dialysis initiation were more likely to die than those who had consistently well-treated anemia.
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NEW ORLEANS—Successful management of anemia in patients with chronic kidney disease may improve their survival after starting hemodialysis (HD), researchers reported at the American Society of Nephrology's Kidney Week 2017 meeting.
Using data from the U.S. Renal Data System, James B. Wetmore, MD, of Hennepin County Medical Center in Minneapolis, Minnesota, and colleagues studied 2 groups of HD patients: 3662 patients whose anemia was consistently well treated (hemoglobin level of 9.0 g/dL or higher) with erythropoiesis-stimulating agents (ESAs) before and after HD initiation and a comparison group of 4461 patients who appeared to have untreated or ineffectively treated anemia prior to HD initiation but who had an elevation in hemoglobin levels with ESA treatment after starting dialysis.
At 3, 6, and 12 months, the well-treated group had a significant 21%, 20%, and 17% decreased risk of all-cause mortality, respectively, and 26%, 26%, and 22% decreased risk of cardiovascular mortality, respectively, relative to the comparison group after adjusting for patients' demographics and comorbidities.
“This suggests that merely ‘rescuing' an anemic patient with ESAs after dialysis is initiated does not make up for the so-called lost time of having low hemoglobins not treated by ESAs in the predialysis period,” Dr Wetmore told Renal & Urology News. “So there's something about being anemic in the predialysis environment that, even if [anemia is] corrected after dialysis is initiated, still confers a risk in the period after dialysis initiation.”
Dr Wetmore's team concluded that failure to achieve a hemoglobin level of at least 9 g/dL through lack of treatment in the predialysis period may represent a missed treatment opportunity to decrease mortality after HD initiation.
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Wetmore JB, Li S, Heng Y, et al. Association of predialysis ESA anemia treatment with mortality after dialysis initiation. Presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31 to Nov. 5). Abstract SA-PO799.