Scientific Poster Session II - Original Research

Abstract

Anemia is a complication of chronic kidney disease (CKD). Erythropoietin stimulating agents (ESAs) lower the need for red blood cell transfusions while increasing hemoglobin concentrations, but increase risk of thrombotic events and tumor growth. In 2021, a black box warning for ESA use was issued for increased risk of death, stroke, venous thromboembolism (VTE), and tumor progression/recurrence.

Research Question or Hypothesis:

This study compared nephrologist prescribing patterns for ESA and iron in patients receiving hemodialysis (HD) admitted for care at an academic medical center.

Study Design:

IRB-approved, single-center, retrospective analysis

Methods:

Patients =18 years diagnosed with CKD receiving HD and were hospitalized between November 2022 – April 2023 were included. The primary outcome assessed was the change in epoetin dose from outpatient to inpatient. Secondary outcomes included the percentage of patients who: received an ESA dose with a Hgb greater than 10 g/dL, had an iron profile collected within 12 weeks from admission, received iron supplementation, received a blood transfusion during admission, had documentation of gastrointestinal bleed (GIB) or VTE, and overall length of hospital admission. Data was analyzed using descriptive statistics, including median values and interquartile ranges.

Results:

Thirty-three patients were included, and 82% had a change in epoetin dose. Of these 27 patients, 56% received an ESA dose exceeding their outpatient dose. Ten patients received one, or more, doses of an ESA despite having a hemoglobin level greater than 10 g/dL. Iron profiles within 12 weeks of admission were present in 10 patients. No patients experienced a GIB or VTE.

Conclusion:

This study highlights variability of nephrology prescribing patterns for ESAs in patients managed by the same group of providers, even when record of outpatient dosing is available. An inpatient order set may aid in identifying patients who would benefit from iron supplementation, reducing unnecessary ESA use, and ensuring those most at need, receive proper ESA dosing.

Presenting Author

Authors