Hyporesponse to anemia drugs leads to higher risk of hospitalizations, death
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Key takeaways:
- Patients on dialysis who are resistant to erythropoiesis-stimulating agents face a higher risk for hospitalizations and death.
- Such patients use more health care resources.
AUSTIN, Texas —Patients on dialysis who are hyporesponsive to anemia treatment have a higher risk for hospitalizations and death, according to data presented here.
“Hyporesponse (hypoR) to erythropoiesis-stimulating agents (ESAs) is associated with adverse events,” Christine Ferro, BA, and colleagues wrote in a poster presented at the National Kidney Foundation Spring Clinical Meetings. “We compared rates of acute inpatient (AIP) admission, 30-day readmission, and mortality between Medicare patients with and without hypoR to ESAs.”
Patients in the study were on dialysis for 6 months or more and had been treated with an ESA. Patients were also stratified by dialysis modality, including hemodialysis only, peritoneal dialysis only or multiple modalities.
Ferro and colleagues defined hypoR as patients receiving a mean ESA weekly dose of more than 300 epoetin alfa units per kg of body weight and a hemoglobin level in the prior month of less than 10 g/dL during 2 or more consecutive months.
Patients were categorized into one of two groups based on the portion of months of hyporesponsiveness: acute hyporesponsiveness (hypoRA, defined as less than 60% of the previous 2 or more consecutive months) and persistent hyporesponsiveness (hypoRP) as greater than 60% of the previous 2 or more consecutive months of being hyporesponsive.
“Rates of AIP admission and 30-day all-cause readmission per patient per year were risk-normalized. Mortality was calculated as percent of [patients] who died in 2019,” the authors wrote.
Of 206,670 patients evaluated in the study, 21,302 (10.3%) met the definition of being hyporesponsive; 92% of the group were on hemodialysis; 6% on peritoneal dialysis, and 2% were on both modalities.
Results showed that AIP admissions were higher among patients with hyporesponsiveness to ESAs (2.9, 1.7 and 3.3 admissions for patients receiving hemodialysis, peritoneal dialysis or on both modalities, respectively) compared with those patients who were not hyporesponsive (1.2, 1 and 2.1 admissions, respectively) in the three modality groups. “A similar pattern was seen for readmission rates,” the authors wrote.
Mortality rates were highest for patients with persistent hypoR; patients receiving peritoneal dialysis “had the lowest rates of all metrics across levels of hypoR to ESA,” the authors wrote.
Kristen Johansen, MD, director of nephrology at Hennepin Healthcare, Minneapolis, and a co-author on the poster, told Healio Nephrology that the lack of consistent hyporesponsiveness in the study group made it more difficult to conclude there was an association with mortality. “Patients who have hyporesponsiveness do have higher mortality, and it is even more so if they have persistent hyporesponsiveness,” Johansen said. “Whether that high mortality is because of hyporesponsiveness is not at all clear,” she said.
The fact that patients on peritoneal dialysis in the study group had a lower rate of hyporesponsiveness “was a little surprising to me,” Johansen said, “because when we look at data cross country, such as in the U.S. Renal Data System, the dose of ESAs is not that different between patients on hemodialysis vs. peritoneal dialysis.”
In their conclusion, the authors wrote: “Among patients receiving [hemodialysis], those with persistent hyporesponse experienced rates of AIP admits and readmits about 100% higher and mortality rates almost 200% higher (23.9%) than patients without hyporesponse (8.0%)."
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Ferro C, et al. Poster #179. Presented at: National Kidney Foundation Spring Clinical Meetings; April 11-15, 2023; Austin, Texas.
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