Stopping Epoetin Regulates High Hemoglobin Levels

Stopping drug appears more effective than reducing dose at normalizing elevated levels

FRIDAY, July 23 (HealthDay News) -- In hemodialysis patients, discontinuation of epoetin may be more effective in normalizing elevated hemoglobin levels than reducing the dose of the drug, according to a study published online July 22 in the Clinical Journal of the American Society Nephrology.

Jose A. Calvo, M.D., of the Tufts University School of Medicine in Boston, and colleagues evaluated hemoglobin levels over a two-month period in 2,789 dialysis patients who discontinued epoetin and 754 dialysis patients who reduced their epoetin dose by 20 to 30 percent after developing hemoglobin levels ≥13 g/dL.

The researchers found that more patients who discontinued epoetin dropped below 11 g/dL (21.5 versus 10.1 percent) and 10 g/dL (7.2 versus 3.6 percent) within two months, compared with patients who reduced their epoetin dose. Reducing the dose of epoetin was linked to more frequent nadir hemoglobin levels greater than 12 g/dL (62.8 versus 31.1 percent). After adjusting for epoetin dose and elevated blood markers of inflammation, patients who discontinued epoetin were 1.91 times more likely to have a lowest hemoglobin level below 10 g/dL, whereas patients who reduced epoetin were 4.41 times as likely to have a lowest hemoglobin level above 12 g/dL.

"Once a maintenance hemodialysis patient achieves a hemoglobin level ≥13 g/dL, an epoetin discontinuation strategy is associated with a higher probability of reaching the hemoglobin target range stipulated by Kidney Disease Outcome Quality Initiative or U.S. Food and Drug Administration guidelines within two months compared with a reduction strategy," the authors write. "However, a discontinuation strategy is associated with a higher likelihood of a low nadir hemoglobin level, whereas a reduction strategy is associated with significantly increased time at higher than desired hemoglobin levels."

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