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Hematocrit Tied to Anemia Treatment Outcomes in Dialysis

Greater use of ESAs, iron found to reduce mortality risk only in patients with lower hematocrit

TUESDAY, March 2 (HealthDay News) -- In patients with end-stage renal disease utilizing hemodialysis, greater use of erythropoiesis-stimulating agents (ESAs) and iron was associated with higher and lower mortality risk, depending on patients' hematocrit levels, according to research published in the March 3 issue of the Journal of the American Medical Association.

M. Alan Brookhart, Ph.D., of the University of North Carolina in Chapel Hill, and colleagues analyzed 1999 to 2007 data from the United States Renal Data system, and characterized the annual anemia management practices at roughly 4,500 U.S. dialysis units. The roughly 270,000 patients in the sample had a mean age of 63 years.

Centers that used higher doses of ESAs in patients with hematocrit less than 30 percent had lower mortality rates than those using smaller doses, the researchers found. Centers more frequently using iron in patients with hematocrit less than 33 percent also had lower mortality rates. Centers using larger ESA doses in patients with hematocrit between 33 and 35.9 percent had higher mortality rates; and, the authors note, more intensive use of both treatments in those with hematocrit of 36 percent or higher was linked to greater mortality risk.

"While lower overall mortality risk occurs at higher hematocrit levels, elevated mortality risk was associated with greater use of ESAs and iron in these patients. Further observational and experimental studies are needed to help identify optimal treatment algorithms for both ESAs and iron that maximize clinical benefit while minimizing adverse outcomes," the authors conclude.

The study was supported by Amgen. Several co-authors reported financial relationships with Amgen or other companies.

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