Effect of long-acting erythropoiesis-stimulating agents on hemoglobin levels at the initiation of dialysis

Background: The goal of the present study was to explore the differences in effects between erythropoiesis-stimulating agent (ESA) types on hemoglobin (Hb) level at the initiation of maintenance dialysis. Methods: This was a cross-sectional study. From January 2006 to October 2012, 2920 patients with end-stage kidney disease commenced hemodialysis (HD) at nine participating hospitals. The criteria for exclusion from the database were (1) presence of cancer or gastrointestinal bleeding and (2) serum C-reactive protein ≥0.3 mg/dL. A total of 1263 patients were entered into the final database. We explored the association of yearly trend of Hb level just before the first HD session with the different types of ESA in the predialysis period. Results: During the 7-year study period, patients' Hb levels at the initiation of dialysis dramatically increased from 8.6 to 9.1 g/dL. Parallel to this increase, the use of long-acting ESA also increased from 0 to 80 %. A higher level of Hb was confirmed in the long-acting ESA group compared with the short-acting group (9.5 vs. 8.7 g/dL, P < 0.01). Multivariate regression analysis showed a strong association of Hb level with the use of long-acting ESA (r = 0.155, P = 0.003), even after adjusting for confounding variables and estimated dose of epoetin. Conclusions: The change in the type of ESA used from short-acting to long-acting played a role in the increase of patients' Hb levels at the initiation of dialysis. A long-acting ESA has the potential effect of maintaining an optimal Hb level even in the advanced stages of CKD.