2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2007040477v1 18/12/3184    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Weiner, D. E. Articles by Meyer, K. B. Search for Related Content PubMed PubMed Citation Articles by Weiner, D. E. Articles by Meyer, K. B.

Reducing versus Discontinuing Erythropoietin at High Hemoglobin Levels

Daniel E. Weiner^*, Dana C. Miskulin^*, Kimberly Seefeld^*, Vladimir Ladik, Philip G. Zager, Ajay K. Singh, H. Keith Johnson^|| and Klemens B. Meyer^*

^* Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts; Keane, Inc., Chicago, Illinois; Division of Nephrology, University of New Mexico, Albuquerque, New Mexico; Renal Division, Brigham and Women's Hospital, Boston, Massachusetts; and ^|| Dialysis Clinic, Inc., Nashville, Tennessee

Correspondence: Dr. Daniel E. Weiner, Division of Nephrology, Box 391, Tufts-New England Medical Center, Boston, MA 02111. Phone: 617-636-5070; Fax: 617-636-7890; E-mail: dweiner{at}tufts-nemc.org

Received for publication April 18, 2007. Accepted for publication July 11, 2007.

A 2006 change in Medicare policy allowed reimbursement for erythropoietin (EPO) in dialysis patients whose most recent hemoglobin exceeded 13 g/dl. We investigated the effects of a change in dosing algorithm implemented in response to this policy, in which EPO dosages were reduced instead of temporarily discontinued for hemoglobin levels 13 g/dl. Among 1688 individuals in 18 hemodialysis units, the reduction protocol resulted in more hemoglobin levels 13 g/dl (P < 0.0001), fewer levels between 11 and 12.9 g/dl (P 0.004), no difference in the proportion of levels <11 g/dl, and more EPO administered per session (P < 0.0001) than the discontinuation protocol. In view of the expense of erythropoiesis stimulating agents and the uncertainty of the safety of using EPO to achieve high hemoglobin targets, this study suggests that discontinuation, rather than reduction, of EPO treatment is appropriate when hemoglobin reaches 13 g/dl in hemodialysis patients.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673