Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Sep;5(9):1621-7.
doi: 10.2215/CJN.02650310. Epub 2010 Jul 22.

Nadir hemoglobin levels after discontinuation of epoetin in hemodialysis patients

Jose A Calvo  1 , Dana C Miskulin, Klemens B Meyer, Daniel E Weiner
Affiliations

Nadir hemoglobin levels after discontinuation of epoetin in hemodialysis patients

Jose A Calvo et al. Clin J Am Soc Nephrol. 2010 Sep.

Abstract

Background and objectives: In hemodialysis patients, both hemoglobin variability and targeting normalization of hemoglobin may have adverse consequences. There are few data on epoetin management in patients achieving high hemoglobin levels.

Design, setting, participants, & measurements: Maintenance hemodialysis patients within Dialysis Clinic Inc. (DCI) who were treated with a 20 to 30% epoetin dose reduction versus epoetin discontinuation following achievement of a hemoglobin level of > or = 13 g/dl were evaluated. The primary outcome was nadir hemoglobin within 2 months of epoetin reduction or discontinuation.

Results: There were 2789 patients in whom epoetin was discontinued and 754 patients in whom epoetin was reduced after hemoglobin > or = 13 g/dl. Patients treated with reduction received significantly more epoetin over the subsequent 2 months. More patients dropped below 11 (21.5 versus 10.1%) and 10 g/dl (7.2 versus 3.6%) within 2 months of discontinuing epoetin, whereas reduction was associated with more frequent nadir hemoglobin levels >12 g/dl (31.1 versus 62.8%). In multivariable models including age, ferritin, albumin, and baseline epoetin dose, discontinuation was associated with nadir hemoglobin below 10 g/dl [OR = 1.91 (CI: 1.22, 2.99)], whereas reduction was associated with a hemoglobin nadir above 12 g/dl [OR = 4.41 (CI: 3.63, 5.37)].

Conclusions: In hemodialysis patients with baseline hemoglobin >13 g/dl, epoetin discontinuation is associated with lower epoetin use and a higher probability of reaching a hemoglobin target range of 10 to 12 g/dl within 2 months; discontinuation is also associated with a higher likelihood nadir hemoglobin <10 g/dl.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Nadir hemoglobin levels within 2 months after either discontinuation (dark bars/line) or reduction (light bars/line) of epoetin. Trend lines represent a running average of the four hemoglobin values before and the four values after each specific hemoglobin point.
See this image and copyright information in PMC

References

    1. Eschbach JW: The anemia of chronic renal failure: Pathophysiology and the effects of recombinant erythropoietin. Kidney Int 35: 134–148, 1989 - PubMed
    1. Eschbach JW, Abdulhadi MH, Browne JK, Delano BG, Downing MR, Egrie JC, Evans RW, Friedman EA, Graber SE, Haley NR, Korbet S, Krantz SB, Lundin AP, Nissenson AR, Ogden DA, Paganini EP, Rader B, Rutsky EA, Stivelman J, Stone WJ, Teschan P, Van Stone JC, Van Wyck DB, Zuckerman K, Adamson JW: Recombinant human erythropoietin in anemic patients with end-stage renal disease. Results of a phase III multicenter clinical trial. Ann Intern Med 111: 992–1000, 1989 - PubMed
    1. Sikole A, Polenakovic M, Spirovska V, Polenakovic B, Masin G: Analysis of heart morphology and function following erythropoietin treatment of anemic dialysis patients. Artif Organs 17: 977–984, 1993 - PubMed
    1. Wizemann V, Schafer R, Kramer W: Follow-up of cardiac changes induced by anemia compensation in normotensive hemodialysis patients with left-ventricular hypertrophy. Nephron 64: 202–206, 1993 - PubMed
    1. Parfrey PS, Lauve M, Latremouille-Viau D, Lefebvre P: Erythropoietin therapy and left ventricular mass index in CKD and ESRD patients: A meta-analysis. Clin J Am Soc Nephrol 4: 755–762, 2009 - PMC - PubMed

Publication types