ErythropoieSIS stimulating agent (ESA) use is increased following missed dialysis sessions

• Main Authors: T. Christopher Bond, Steven Wang, Jaime Rubin, Alex Yang
• Format: Article
• Language: English
• Published: The Korean Society of Nephrology 2012-06-01
• Series: Kidney Research and Clinical Practice
• Online Access: http://www.sciencedirect.com/science/article/pii/S221191321200438X

Missed dialysis sessions can have a cascading effect on patient clinical outcomes. In addition to missing the dialysis itself, patients fail to receive medications—such as ESAs—that are dosed at each session. This analysis assessed ESA dose changes following missed session episodes in order to evaluate “catch-up dosing.” In a retrospective analysis, we assessed missed session and epoetin alfa (EPO) utilization data in 2010 from adult (≥ 18 yrs old), hemodialysis (HD) patients. Consecutive misses were considered part of a missed session “episode.” All misses were included (even if patient was hospitalized). Differences in EPO utilization in the periods 14 days, 30 days and 31-60 days before and after missed session episodes were calculated and stratified by length of episode, and whether additional sessions were missed in the before/after periods. Total monthly EPO dose was also calculated and stratified by number of missed sessions. Patients used significantly more EPO after a missed session episode, and differences in per session EPO dose were generally greater the longer the episode. For missed session episodes with no additional misses in the 30 day before/after period, increases of 18% to 30% per session were seen, depending on episode length. For longer episodes, usually due to hospitalization, differences were sustained over 60 days. Analyses which included additional missed sessions in the before/after period showed similar patterns. Beyond these per-session associations, the total amount of EPO used in a month increased with number of missed sessions (through up to 5 missed sessions), even though these patients (by definition) were not receiving as many administrations of EPO. Missed session episodes result in significant increases in ESA utilization in the post-miss period, and also in total monthly ESA use. Such increases should be considered in any assessment of impact of missed sessions: both clinical and economic.