Victoria Socha

DocwireNews

Patients with dialysis-dependent chronic kidney disease (DDP-CKD) who experience hyporesponse to erythropoiesis-stimulating gents (ESAs) face increased risk for adverse events. Christine Ferro, CHFP, and colleagues conducted an analysis to compare rates of acute inpatient admission, 30-day readmission, and mortality among Medicare beneficiaries with and without hyporesponse to ESAs.Results were reported during a poster session at the National Kidney Foundation Spring Clinical Meetings 2032. The poster was titled Inpatient Admission and Mortality Rates Among Medicare Patients With Dialysis-Dependent CKD and Hyporesponse to ESAs.The researchers used data from Medicare fee-for-service beneficiaries to identify patients receiving 6 or more months of outpatient dialysis with concurrent ESA use in 2019. Patients were stratified by dialysis modality: hemodialysis only; peritoneal dialysis only; and hemodialysis plus peritoneal dialysis. Hyporesponse was defined as two consecutive months where (1) mean ESA weekly dose surpassed 300 epoetin alfa units per kg of bodyweight and (2) hemoglobin level in the prior month &lt;10 g/dL.Patients were classified based on the portion of months flagged as acute hyporesponse (&lt;60%) or persistent hyporesponse (&ge;60%). Rates of acute inpatient 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.Of 206,670 patients in the database, 10.3% (n=21,302) met the definition of hyporesponse: 92% on the hemodialysis group, 6% in the peritoneal dialysis group, and 2% in the hemodialysis plus peritoneal dialysis group. Acute inpatient admissions were higher among patients with persistent hyporesponse (2.9, 1.7, and 3.3 admissions per patient per year for patients in the hemodialysis group, peritoneal group, and the hemodialysis plus peritoneal dialysis group, respectively) versus those with acute hyporesponse (2.3, 1.6, 3.2) and those without hyporesponse (1.2, 1.0, and 2.1). The pattern for readmission rates was similar.Mortality rates increased with hyporesponse: 6.1%-8.0% for patients without hyporesponse, 8.8% -12.9% for patients with acute hyporesponse, and 10.0%-23.9% for patients with persistent hyporesponse. The lowest rates of all metrics across levels of hyporesponse to ESA were among patients receiving peritoneal dialysis.In summary, the authors said, &ldquo;Rates of adverse events increase with persistence of hyporesponse. Among patients receiving hemodialysis, those with persistent hyporesponse experienced rates of acute inpatient admits and readmits about 100% higher, and mortality rates almost 200% higher (23.9%) than patients without hyporesponse (8.0%). These findings suggest that patients with hyporesponse use more health care resources, and alternative anemia therapies are needed.&rdquo;Source: Ferro VC, Benjumea D, Dieguez G, Metz S, Harrigan K, Johansen KL. Inpatient admission and mortality rates among Medicare patients with dialysis-dependent CKD and hyporesponse to ESAs. Poster #179. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas.

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Hyporesponse to ESAs Among Patients With DDP-CKD

Anemia and Kidney Disease

Comparison of rates of acute inpatient admission, 30-day readmission, and mortality among Medicare beneficiaries with and without hyporesponse to ESAs.

Patients With Dialysis-Dependent CKD and Hyporesponse to ESAs

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