Document Detail


Nadir hemoglobin levels after discontinuation of epoetin in hemodialysis patients.
MedLine Citation:
PMID:  20651155     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: In hemodialysis patients, both hemoglobin variability and targeting normalization of hemoglobin may have adverse consequences. There are few data on epoetin management in patients achieving high hemoglobin levels.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Maintenance hemodialysis patients within Dialysis Clinic Inc. (DCI) who were treated with a 20 to 30% epoetin dose reduction versus epoetin discontinuation following achievement of a hemoglobin level of > or = 13 g/dl were evaluated. The primary outcome was nadir hemoglobin within 2 months of epoetin reduction or discontinuation.
RESULTS: There were 2789 patients in whom epoetin was discontinued and 754 patients in whom epoetin was reduced after hemoglobin > or = 13 g/dl. Patients treated with reduction received significantly more epoetin over the subsequent 2 months. More patients dropped below 11 (21.5 versus 10.1%) and 10 g/dl (7.2 versus 3.6%) within 2 months of discontinuing epoetin, whereas reduction was associated with more frequent nadir hemoglobin levels >12 g/dl (31.1 versus 62.8%). In multivariable models including age, ferritin, albumin, and baseline epoetin dose, discontinuation was associated with nadir hemoglobin below 10 g/dl [OR = 1.91 (CI: 1.22, 2.99)], whereas reduction was associated with a hemoglobin nadir above 12 g/dl [OR = 4.41 (CI: 3.63, 5.37)].
CONCLUSIONS: In hemodialysis patients with baseline hemoglobin >13 g/dl, epoetin discontinuation is associated with lower epoetin use and a higher probability of reaching a hemoglobin target range of 10 to 12 g/dl within 2 months; discontinuation is also associated with a higher likelihood nadir hemoglobin <10 g/dl.
Authors:
Jose A Calvo; Dana C Miskulin; Klemens B Meyer; Daniel E Weiner
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-07-22
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  5     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-08     Completed Date:  2011-01-11     Revised Date:  2011-09-13    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1621-7     Citation Subset:  IM    
Affiliation:
Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA. dweiner@tuftsmedicalcenter.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Chi-Square Distribution
Drug Administration Schedule
Erythropoietin, Recombinant / administration & dosage*
Female
Hematinics / administration & dosage*
Hemoglobins / metabolism*
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Renal Dialysis*
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Grant Support
ID/Acronym/Agency:
K23DK071636/DK/NIDDK NIH HHS; T32DK007777/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Erythropoietin, Recombinant; 0/Hematinics; 0/Hemoglobins
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