University Of North CarolinaEnd-stage renal disease (ESRD) is when the kidneys will never function from now onwards and is permanently damaged. Larger use of erythropoiesis-stimulating agents (ESAs) and more recurrent use of iron at lesser hematocrit levels may be linked to a reduced thereat of death for hemodialysis patients. This is what a study claims.

Apparently, there appears to be a difference of opinion concerning the suitable management of anemia in ESRD.

The authors commented, “Appropriate use of ESAs [which stimulate red blood cell production] and intravenous iron can effectively manage the anemia of chronic kidney disease and end-stage renal disease (ESRD), but several randomized trials have reported an increased risk of mortality and cardiovascular events in patients treated to achieve higher hematocrit levels. The earlier of these reports prompted the U.S. Food and Drug Administration in March 2007 to issue a black box warning for all ESAs recommending that they be used at the lowest level necessary to prevent transfusions.”

M. Alan Brookhart, Ph.D., of the University of North Carolina, Chapel Hill, and colleagues apparently examined the 1-year mortality threat linked to diverse dialysis center-level patterns of ESA and intravenous iron application for roughly 2,69,717 new hemodialysis patients. By means of data from Medicare’s ESRD program (1999-2007), the scientists typified every U.S. dialysis center’s annual anemia management practice by approximating its usual use of ESAs and intravenous iron in hemodialysis patients in 4 hematocrit groups.

After regulating several aspects, it was seen that specific patterns of ESA and iron use by dialysis centers appear to be linked to diverse mortality threats among new patients at those centers. Centers that supposedly made use of bigger doses of ESAs in patients with hematocrit lower than 30 percent apparently attained lower mortality rates, while mortality rates seemed to be augmented in centers that applied more ESA doses in patients with hematocrit between 33 percent and 35.9 percent and in those with hematocrit of 36 percent or more.

The authors mentioned, “We observed decreased mortality in centers that used iron more frequently in patients with hematocrit less than 30 percent and in patients with hematocrit between 30 percent and 32.9 percent. We also observed increasing mortality rates in centers that used iron more frequently in patients with hematocrit levels of 36 percent or higher.”

The authors added that 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 study was published in JAMA.