title: Nadir hemoglobin levels after discontinuation of epoetin in hemodialysis patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA. dweiner@tuftsmedicalcenter.org
authors.forename: Jose A
authors.initials: JA
authors.lastname: Calvo
authors.forename: Dana C
authors.initials: DC
authors.lastname: Miskulin
authors.forename: Klemens B
authors.initials: KB
authors.lastname: Meyer
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011994:Recombinant Proteins; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin