Victoria Socha

DocwireNews

Patients with end-stage kidney disease (ESKD) receiving maintenance hemodialysis frequently develop anemia. There are associations between anemia in ESKD and increased risk of morbidity and mortality. Anemia correction was revolutionized with the use of recombinant human erythropoietin (rHuepO), however, there were concerns regarding development or worsening of hypertension.Anika T. Singh and colleagues conducted a study to examine practice patterns of erythropoiesis-stimulating agents (ESA) in outpatient hemodialysis patients and to identify associations of ESA use with Hyper0 (any increase in systolic blood pressure from pre- to posthemodialysis) and perihemodialysis blood pressure parameters. Results were reported during a poster session at the American Society of Nephrology Kidney Week 2023 in a poster titled Association of Erythropoiesis-Stimulating Agents With Peridialytic Blood Pressure Parameters.DaVita Biorepository, a prospective cohort study database of clinical data and biospecimen collection, was used to assess administration of ESAs at individual hemodialysis sessions. The analysis included unadjusted and multivariable Poisson and linear random effects models adjusted for age, sex, race, access, prehemodialysis systolic blood pressure, hemodialysis vintage, ultrafiltration rate, diabetes , heart failure, ischemic heart disease, peripheral vascular disease, and lung disease. Further analysis included exploratory models adjusted for those variables plus hemoglobin and endothelin-1 (ET-1).Mean age of the analysis cohort was 53 years, 44% were women, and 38% were Black. Mean prehemodialysis systolic blood pressure was 152 mm Hg. ESAs were administered at 71.5% of the hemodialysis sessions (n=97,172/135,892). Recipients of ESAs were younger, had higher ultrafiltration volume and rate, longer hemodialysis sessions, higher prehemodialysis systolic blood pressure, diabetes, peripheral vascular disease, and higher hemoglobin and ET-1.In results of fully adjusted models, there was a 9% higher rate of Hyper0. The association was mildly attenuated in exploratory models adjusted for hemoglobin plus ET-1. In fully adjusted models of perihemodialysis parameters, there was an association between ESAs and a higher nadir of systolic blood pressure; similar patterns of associations were noted for ESAS and posthemodialysis systolic blood pressure.&ldquo;We observed an independent association between ESA administration and higher risk of Hyper0, and higher intradialytic systolic blood pressure parameters, &ldquo; the researchers said. &ldquo;Future studies are warranted to better understand the mechanisms underlying these findings.&rdquo;Source: Singh AT, Yen TE, Sarvode Mothi, S, Waikar S, McCausland FR. Association of erythropoiesis-stimulating agents with peridialytic blood pressure parameters. TH-PO299. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania.

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Erythropoiesis-Simulating Agents and Peridialytic Blood Pressure Parameters

Anemia and Kidney Disease

There was an association between ESAs and a higher nadir of systolic blood pressure; similar patterns were noted for ESAS and posthemodialysis systolic blood pressure.

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