Nocturnal Dialysis Decreases EPO Use
Robert S. Lockridge, Jr., MD, of Lynchburg Nephrology in
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
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.