title: The association of race with erythropoietin dose in patients on long-term hemodialysis.
abstract: BACKGROUND
  Medicare data indicate that black hemodialysis patients receive greater doses of erythropoietin (EPO) than white patients when achieving similar hemoglobin levels. We confirmed and evaluated this observed association between race and EPO dose.
  
  
  METHODS
  Cross-sectional cohort study.
  
  
  METHODS
  Primary Medicare-insured white (57%) and black (43%) adult long-term hemodialysis patients treated by Fresenius Medical Care who received EPO from January 1 to 31, 2004 (N = 44,721).
  
  
  METHODS
  White/black race.
  
  
  RESULTS
  Average weekly EPO dose.
  
  
  METHODS
  Associations between race and baseline demographic and laboratory variables were evaluated by using logistic and linear regression models. Correlates of log-transformed weekly EPO dose were determined using linear regression models.
  
  
  RESULTS
  Black patients received 12.6% more EPO than white patients (95% limits, 10.9% to 14.3%; P < 0.001). This racial difference in EPO dose was observed across similar hemoglobin levels despite fewer catheters (P < 0.001) and fewer prior hospitalization events in black patients (P = 0.002). Black patients were younger and had larger body size and greater albumin and biointact parathyroid hormone levels, but lower equilibrated Kt/V and white blood cell counts (all P < 0.001). In the 95th percentile of EPO dose (those receiving > 60,000 U/wk), there was a greater proportion of black patients (6% of total black population compared with only 4% in all white patients; P < 0.001). The difference in EPO dose between black and white patients was modified by age and was significant at ages younger than 45 and 65 years or older.
  
  
  CONCLUSIONS
  Observational study limited to white and black adult Medicare patients only, correlating with EPO doses from a single month, without adjustment for comorbid conditions.
  
  
  CONCLUSIONS
  Black patients were administered approximately 12% greater EPO doses than white patients while achieving similar hemoglobin levels. We identified variables that differed across race that may explain this difference, but they were either not actionable or presented limited opportunity for intervention. Additional studies are needed to define a physiological (or pathological) basis for these observations.
authors.affiliation: Fresenius Medical Care, North America, Waltham, MA 02451-1457, USA. elacsonj@fmcna.com
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lacson
authors.forename: John
authors.initials: J
authors.lastname: Rogus
authors.forename: Ming
authors.initials: M
authors.lastname: Teng
authors.forename: J Michael
authors.initials: JM
authors.lastname: Lazarus
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Hakim
mesh_terms: D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors; D044465:White People
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin