Hyporesponse to anemia drugs leads to higher rate of transfusions
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Key takeaways:
- Hyporesponsiveness to erythropoiesis-stimulating agents leads to a greater likelihood of increased red cell blood transfusions.
- The transfusion rate did not impact the rate of transplants in the study group.
AUSTIN, Texas — Patients on dialysis who are hyporesponsive to anemia treatment will likely experience more red blood cell transfusions, according to data presented at the National Kidney Foundation Spring Clinical Meetings.
“Hyporesponse (hypoR) to erythropoiesis-stimulating agents (ESAs) is associated with adverse events and poor outcomes leading to high health care utilization,” Christine Ferro, BA, and colleagues wrote in a poster presentation. “We compared rates of [red blood cell transfusions (RBCTs)] and kidney transplantations between Medicare patients with and without hypoR to ESAs.”
Patients who had been on dialysis for at least 6 months and had received ESA treatment in 2019 were included in the study (n = 206,670). “All patients were Medicare fee-for-service beneficiaries,” the authors reported.
Patients in the study were grouped by their choice of dialysis modality: hemodialysis only, peritoneal dialysis only and multiple modalities (hemodialysis and peritoneal dialysis).
“We defined hypoR as patients with 2 consecutive months where mean ESA weekly dose was > 300 epoetin alfa units/kg and patient’s hemoglobin level in [the] prior month was < 10 g/dL,” Ferro and colleagues wrote. “Patients were classified based on the portion of months flagged as acute hypoR (< 60%) and persistent hypoR ( 60%).”
Researchers identified 21,302 (10.3%) patients who met the definition of hypoR to ESAs. Of that group, 92% were on hemodialysis, 6% on peritoneal dialysis and 2% on both.
They found that patients with persistent hypoR had higher mean days of RBCTs (3.3 for patients receiving hemodialysis, 2.1 for peritoneal dialysis and 2.8 for both) than those with acute hypoR (1.1, 0.7, and 1.5, respectively) or without hypoR (0.3, 0.3 and 0.6, respectively). The lowest rates of RBCTs occurred among patients receiving peritoneal dialysis. Those patients also had the highest risk-normalized rates of kidney transplants (0.02-0.06 vs. 0.01 for those receiving hemodialysis) per patient per year across all levels of hypoR.
“Use of RBCTs increased with persistence of hyporesponse to ESAs, with mean days of transfusion almost 12 times higher for patients with hyporesponse (3.27) than without (0.26) among those receiving [hemodialysis],” Ferro and the authors wrote. “Rates of kidney transplants were highest among patients receiving [peritoneal dialysis] regardless of hyporesponse.”
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Ferro C, et al. Poster #180. Presented at: National Kidney Foundation Spring Clinical Meetings; April 11-15, 2023; Austin, Texas.
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