@article{16280,
  author = {McMahon L. and Cai M. and Baweja S. and Holt S. and Kent A. and Leikis M. and Becker G. and Perkovic Vlado},
  title = {Mortality in dialysis patients may not be associated with ESA dose: a 2-year prospective observational study},
  abstract = {<p>
ABSTRACT: BACKGROUND: Anaemia of chronic kidney disease increases the risk of death and adverse events, but can be managed using erythropoiesis stimulating agents (ESAs). However, recent evidence suggests that targeting a higher haemoglobin concentration ([Hb]) increases mortality risk, and both higher [Hb] targets and ESA doses have been implicated. Nonetheless, a causative role has not been demonstrated, and this potential relationship requires further appraisal in such a complex patient group. METHODS: The relationship between the haematopoietic response to ESAs and patient survival in 302 stable, prevalent dialysis patients was explored in a prospective, single-centre study. Clinical and laboratory parameters influencing mortality and ESA resistance were analysed. Patients were stratified into 5 groups, according to their [Hb] and ESA dosage, and were followed for 2 years. RESULTS: Little difference in co-morbidities between groups was identified. 73 patients died and 36 were transplanted. Initial analysis suggested a direct relationship between mortality and ESA dosage. However, Cox proportional hazards multivariate analysis demonstrated mortality risk was associated only with age (adjusted HR per year: 1.061, 95% CI 1.031-1.092), dialysis duration (adjusted HR: 1.010, 95% CI 1.004-1.016), peripheral vascular disease (adjusted HR: 1.967, 95% CI 1.083-3.576) and CRP (adjusted HR: 1.024, 95% CI 1.011-1.039). Mortality was increased in patients poorly responsive to ESAs (55.5%). CONCLUSION: ESA dose does not appear to contribute substantially to mortality risk in dialysis patients. Instead, age and co-morbidities appear to be the critical determinants. A poor response to ESAs is a marker of overall poor health status.
</p>
},
  year = {2012},
  journal = {BMC Nephrol},
  volume = {13},
  edition = {2012/06/19},
  number = {1},
  pages = {40},
  month = {-35757923164},
  isbn = {1471-2369 (Electronic)1471-2369 (Linking)},
  note = {McMahon, Lawrence PCai, Michael XBaweja, SanjeevHolt, Stephen GKent, Annette BPerkovic, VladoLeikis, Murray JBecker, Gavin JBMC Nephrol. 2012 Jun 15;13(1):40.},
  language = {Eng},
}