title: Individualized anemia management reduces hemoglobin variability in hemodialysis patients.
abstract: One-size-fits-all protocol-based approaches to anemia management with erythropoiesis-stimulating agents (ESAs) may result in undesired patterns of hemoglobin variability. In this single-center, double-blind, randomized controlled trial, we tested the hypothesis that individualized dosing of ESA improves hemoglobin variability over a standard population-based approach. We enrolled 62 hemodialysis patients and followed them over a 12-month period. Patients were randomly assigned to receive ESA doses guided by the Smart Anemia Manager algorithm (treatment) or by a standard protocol (control). Dose recommendations, performed on a monthly basis, were validated by an expert physician anemia manager. The primary outcome was the percentage of hemoglobin concentrations between 10 and 12 g/dl over the follow-up period. A total of 258 of 356 (72.5%) hemoglobin concentrations were between 10 and 12 g/dl in the treatment group, compared with 208 of 336 (61.9%) in the control group; 42 (11.8%) hemoglobin concentrations were <10 g/dl in the treatment group compared with 88 (24.7%) in the control group; and 56 (15.7%) hemoglobin concentrations were >12 g/dl in the treatment group compared with 46 (13.4%) in the control group. The median ESA dosage per patient was 2000 IU/wk in both groups. Five participants received 6 transfusions (21 U) in the treatment group, compared with 8 participants and 13 transfusions (31 U) in the control group. These results suggest that individualized ESA dosing decreases total hemoglobin variability compared with a population protocol-based approach. As hemoglobin levels are declining in hemodialysis patients, decreasing hemoglobin variability may help reduce the risk of transfusions in this population.
authors.affiliation: Department of Medicine and.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Gaweda
authors.forename: George R
authors.initials: GR
authors.lastname: Aronoff
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Jacobs
authors.forename: Shesh N
authors.initials: SN
authors.lastname: Rai
authors.forename: Michael E
authors.initials: ME
authors.lastname: Brier
mesh_terms: D000368:Aged; D000465:Algorithms; D000740:Anemia / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine; D006435:Renal Dialysis
chemical_list: D006397:Hematinics; D006454:Hemoglobins
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