Anemia Evaluation and Erythropoietin Dose Requirement Among Hemodialysis Patients: a Multicenter Study.
BACKGROUND
Both anemia and high doses of erythropoietin have been associated with increased mortality among dialysis patients. This study was conducted to evaluate the effective dose of erythropoiesis-stimulating agents.


METHODS
This multicenter nationwide cross-sectional study assessed adult patients on hemodialysis for at least 3 months from 80 hemodialysis centers in Iran. Demographic data, erythropoietin dose, and laboratory data were collected.


RESULTS
A total of 7009 prevalent hemodialysis patients were enrolled. Fifty-five percent of the patients had their hemoglobin levels within the target values. In those with a hemoglobin level of 8 g/dL to 10 g/dL, an erythropoietin dose of 10000 IU/wk to 12000 IU/wk led to a significant increase in hemoglobin level. A mean erythropoietin dose of 7700 IU/wk was effective in maintaining the target hemoglobin of 10 g/dL to 12 g/dL during a 3-month follow-up period. Improvement in hemoglobin level was associated with male sex, diabetes mellitus, and hemodialysis adequacy, and its deterioration with lower parathyroid hormone, calcium-phosphorus product, and creatinine levels; malnutrition; transfusion; and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (R2 = 29.1%, P < .001). A dosage of 66.5 IU/kg/wk led to 1 g/dL increase in hemoglobin in anemic patients.


CONCLUSIONS
Data suggested that an estimated erythropoietin dose of 66.5 IU/kg/wk for each 1 g/dL hemoglobin level below the target could be used as a guide for prescription. A dosage of about 8000 IU/wk could help maintaining hemoglobin within the target. A longitudinal study is needed to estimate the required erythropoietin dose.
Mohsen
M
Nafar
Department of Nephrology, Shahid Labbafinejad Medical Center; Kidney Disease Research Center; Shahid Beheshti University of Medical Sciences, Tehran, Iran. samavat@sbmu.ac.ir.
Shiva
S
Samavat
Alireza
A
Khoshdel
Behrang
B
Alipour-Abedi
D000328:Adult; D000740:Anemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000032:analysis / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007492:Iran / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods / Q000401:mortality
D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin