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Sickle cell trait linked to increased ESA dosing among black dialysis patients
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Hemoglobinopathy traits such as sickle cell trait and hemoglobin C trait may account for the higher doses of erythropoiesis-stimulating agents needed to control anemia in black hemodialysis patients, according to results of a cross-sectional study.
Researchers evaluated residual blood samples from 5,319 adult black patients undergoing hemodialysis in the United States. Of this cohort, 671 (12.6%) patients were found to carry a hemoglobinopathy trait, 542 (10.2%) had sickle cell trait and 129 (2.4%) had hemoglobin C trait.
In contrast to incidence estimates among the general population, sickle cell trait was found to be more common in dialysis-dependent chronic kidney disease (10.2% vs. 6.5%-8.6%, P<.001). After excluding 317 patients who received no ESAs, the researchers categorized 5,002 black patients based on presence or absence of hemoglobinopathies.
Across all groups, the mean achieved hemoglobin was almost indistinguishable (11.3 mg/dL in normal hemoglobin vs. 11.2 mg/dL in sickle cell trait and 11.3 mg/dL in hemoglobin C trait, P=.20) and met the clinical target of 10 g/dL to 12 g/dL. Patients with any hemoglobinopathy trait had a roughly 7.9% higher median ESA dose per treatment compared with the normal hemoglobin group (4,737.4 vs. 4,364.1 units/treatment, P=.02).
Multivariable analyses revealed an association between hemoglobinopathy traits and a 13.2% higher ESA dosage per treatment (P=.001). When considered separately, the percent increase in either trait was found to be similar (P=.10). Similar correlations were found when applying sensitivity analyses using weight-based dosing and separate logistic regression models.
The researchers estimated that the roughly 13% increase in ESA dosage among patients with hemoglobinopathies may translate to $30 million annually in increased costs.
“Future work must identify whether this increase in dose is associated with an increase in morbidity and mortality, and whether anemia management and dialysis therapy can be further optimized for patients with hemoglobinopathy traits,” the researchers wrote.
Disclosure: The researchers report employment relationships with Fresenius Medical Care North America and Spectra Laboratories Inc.
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