Hemodialysis treatment time versus erythropoietin dose requirement: Reduction in 2,000 units per week by extension of hemodialysis for 1 hour


Atsuhiro Maeda, Kazuhiko Tsuruya, Maki Maeda, Masatora Yamasaki, Aki Nakashima, Yui Nakashima, Saori Date, Toshiro Maeda, Masafumi Kamijyou, Takuya Kubara, Waka Hayashi, Takanari Kitazono

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: High-dose erythropoietin (EPO) administration to hemodialysis (HD) patients with EPO hyporesponsiveness, due to iron deficiency, hyperparathyroidism, malnutrition, inflammation, and inadequate HD, results in increased risk of mortality and cardiovascular events. We investigated the relationship of the EPO dose requirement with 4-, 5-, and 6-hour HD treatment times. MATERIALS AND METHODS: This cross-sectional study enrolled 300 HD patients, including those on 4-hour HD (n = 78), 5-hour HD (n = 106), and 6-hour HD (n = 116). We studied the following parameters: weekly EPO dose, hemoglobin (Hb), serum ferritin, Kt/V, membrane surface area, quantity of blood flow, quantity of dialysate flow, age, HD vintage, serum albumin, C-reactive protein (CRP), intact parathyroid hormone (iPTH), and β2-microglobulin. These parameters were analyzed with JMP9TM statistical software. FINDINGS: The EPO requirement (units per week) of the 6-hour HD group (4,035 ± 269) was significantly lower than that of the 5-hour HD group (6,628 ± 630), which was significantly lower than that of the 4-hour HD group (8,567 ± 684). The Hb level, mean corpuscular volume, quantity of blood flow, quantity of dialysate flow, age, gender, ratio of diabetic patients, body mass index, dry weight, CRP, iPTH, use of antiplatelet agents and anticoagulants were not significantly different among the three groups. Multiple regression analysis with the weekly EPO requirement as the dependent variable showed HD treatment time (p < 0.0001) and CRP level (p < 0.001) as the significant independent variables. DISCUSSION: The EPO dose can be reduced by ~ 2,000 U/week by extending the HD treatment time for 1 hour; annual cost savings were calculated to be USD 570 per patient.

Original languageEnglish
Pages (from-to)174-179
Number of pages6
JournalClinical nephrology
Volume92
Issue number4
DOIs
Publication statusPublished - Oct 1 2019

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Erythropoietin
Renal Dialysis
Therapeutics
C-Reactive Protein
Dialysis Solutions
Parathyroid Hormone
Hemoglobins
Erythrocyte Indices
Cost Savings
Hyperparathyroidism
Platelet Aggregation Inhibitors
Ferritins
Serum Albumin
Malnutrition
Anticoagulants
Body Mass Index
Software
Iron
Cross-Sectional Studies
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Nephrology

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Hemodialysis treatment time versus erythropoietin dose requirement : Reduction in 2,000 units per week by extension of hemodialysis for 1 hour
. / Maeda, Atsuhiro; Tsuruya, Kazuhiko; Maeda, Maki; Yamasaki, Masatora; Nakashima, Aki; Nakashima, Yui; Date, Saori; Maeda, Toshiro; Kamijyou, Masafumi; Kubara, Takuya; Hayashi, Waka; Kitazono, Takanari.

In: Clinical nephrology, Vol. 92, No. 4, 01.10.2019, p. 174-179.

Research output: Contribution to journalArticle

Maeda, A, Tsuruya, K, Maeda, M, Yamasaki, M, Nakashima, A, Nakashima, Y, Date, S, Maeda, T, Kamijyou, M, Kubara, T, Hayashi, W & Kitazono, T 2019, 'Hemodialysis treatment time versus erythropoietin dose requirement: Reduction in 2,000 units per week by extension of hemodialysis for 1 hour
', Clinical nephrology, vol. 92, no. 4, pp. 174-179. https://doi.org/10.5414/CN109403
Maeda, Atsuhiro ; Tsuruya, Kazuhiko ; Maeda, Maki ; Yamasaki, Masatora ; Nakashima, Aki ; Nakashima, Yui ; Date, Saori ; Maeda, Toshiro ; Kamijyou, Masafumi ; Kubara, Takuya ; Hayashi, Waka ; Kitazono, Takanari. / Hemodialysis treatment time versus erythropoietin dose requirement : Reduction in 2,000 units per week by extension of hemodialysis for 1 hour
. In: Clinical nephrology. 2019 ; Vol. 92, No. 4. pp. 174-179.
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AU - Tsuruya, Kazuhiko

AU - Maeda, Maki

AU - Yamasaki, Masatora

AU - Nakashima, Aki

AU - Nakashima, Yui

AU - Date, Saori

AU - Maeda, Toshiro

AU - Kamijyou, Masafumi

AU - Kubara, Takuya

AU - Hayashi, Waka

AU - Kitazono, Takanari

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N2 - INTRODUCTION: High-dose erythropoietin (EPO) administration to hemodialysis (HD) patients with EPO hyporesponsiveness, due to iron deficiency, hyperparathyroidism, malnutrition, inflammation, and inadequate HD, results in increased risk of mortality and cardiovascular events. We investigated the relationship of the EPO dose requirement with 4-, 5-, and 6-hour HD treatment times. MATERIALS AND METHODS: This cross-sectional study enrolled 300 HD patients, including those on 4-hour HD (n = 78), 5-hour HD (n = 106), and 6-hour HD (n = 116). We studied the following parameters: weekly EPO dose, hemoglobin (Hb), serum ferritin, Kt/V, membrane surface area, quantity of blood flow, quantity of dialysate flow, age, HD vintage, serum albumin, C-reactive protein (CRP), intact parathyroid hormone (iPTH), and β2-microglobulin. These parameters were analyzed with JMP9TM statistical software. FINDINGS: The EPO requirement (units per week) of the 6-hour HD group (4,035 ± 269) was significantly lower than that of the 5-hour HD group (6,628 ± 630), which was significantly lower than that of the 4-hour HD group (8,567 ± 684). The Hb level, mean corpuscular volume, quantity of blood flow, quantity of dialysate flow, age, gender, ratio of diabetic patients, body mass index, dry weight, CRP, iPTH, use of antiplatelet agents and anticoagulants were not significantly different among the three groups. Multiple regression analysis with the weekly EPO requirement as the dependent variable showed HD treatment time (p < 0.0001) and CRP level (p < 0.001) as the significant independent variables. DISCUSSION: The EPO dose can be reduced by ~ 2,000 U/week by extending the HD treatment time for 1 hour; annual cost savings were calculated to be USD 570 per patient.

AB - INTRODUCTION: High-dose erythropoietin (EPO) administration to hemodialysis (HD) patients with EPO hyporesponsiveness, due to iron deficiency, hyperparathyroidism, malnutrition, inflammation, and inadequate HD, results in increased risk of mortality and cardiovascular events. We investigated the relationship of the EPO dose requirement with 4-, 5-, and 6-hour HD treatment times. MATERIALS AND METHODS: This cross-sectional study enrolled 300 HD patients, including those on 4-hour HD (n = 78), 5-hour HD (n = 106), and 6-hour HD (n = 116). We studied the following parameters: weekly EPO dose, hemoglobin (Hb), serum ferritin, Kt/V, membrane surface area, quantity of blood flow, quantity of dialysate flow, age, HD vintage, serum albumin, C-reactive protein (CRP), intact parathyroid hormone (iPTH), and β2-microglobulin. These parameters were analyzed with JMP9TM statistical software. FINDINGS: The EPO requirement (units per week) of the 6-hour HD group (4,035 ± 269) was significantly lower than that of the 5-hour HD group (6,628 ± 630), which was significantly lower than that of the 4-hour HD group (8,567 ± 684). The Hb level, mean corpuscular volume, quantity of blood flow, quantity of dialysate flow, age, gender, ratio of diabetic patients, body mass index, dry weight, CRP, iPTH, use of antiplatelet agents and anticoagulants were not significantly different among the three groups. Multiple regression analysis with the weekly EPO requirement as the dependent variable showed HD treatment time (p < 0.0001) and CRP level (p < 0.001) as the significant independent variables. DISCUSSION: The EPO dose can be reduced by ~ 2,000 U/week by extending the HD treatment time for 1 hour; annual cost savings were calculated to be USD 570 per patient.

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