Kidney Research and Clinical Practice (Jun 2012)
Increases In Erythropoiesis Stimulating Agent (Esa) Use After Hospitalization Of End Stage Renal Disease (Esrd) Patients
Abstract
Hemodialysis (HD) patients are frequently hospitalized. Interruption of normal dialysis and 3x/weekly ESA treatments, along with the cause of hospitalization, normally leads to declines in Hb and increased ESA utilization post-hospitalization. In this retrospective analysis, we examined Hb levels and ESA use before and after hospitalization in adult (≥18 yrs old) HD patients from 1/1/2009-12/31/2010. Hospitalizations preceded by > 30 hospital-free days were included in the analysis. Pre and post-hospitalization Hb test data was available for 156,353 events: 67.4% showed a drop in Hb levels in the 30 days after hospitalization, 0.7% had no change and 32.7% exhibited a rise in Hb levels. For patients with falling Hb, the mean level after hospitalization was 10.55 g/dL, compared to 11.87 g/dL before hospitalization, corresponding to a mean drop of 1.32 g/dL (SD=1.00). Mean monthly Hb levels for all patients were 11.48 g/dL and 10.88 g/dL before and after hospitalization, respectively. ESA dose changes were assessed for 179,929 hospitalization events. Analysis of ESA use over 30 days before/after hospitalization showed increased epoetin alfa (EPO) use post-hospitalization in 60.8% of events, 4.9% showed no mean change, and 34.3% showed a drop in EPO use. Of the hospitalizations with mean per-session increases in EPO, in 69.7% of events the rise in EPO dose occurred before the first post-hospitalization Hb test result was known, and in 30.3% the increase occurred after Hb testing. We found that hospitalizations frequently lead to a drop in patients’ Hb levels and an increase in post-hospitalization EPO dose. However, EPO dose increases often occur before post-hospitalization Hb levels are known. Strategies for better management of anemia in the post-hospitalization period should be assessed.