Use of erythropoietin before the initiation of dialysis and its impact on mortality

Erythropoietin (EPO) is recommended in individuals progressing toward end-s tage renal disease (ESRD) to correct anemia and its complications, which ar e common in this disease. This study evaluated the impact of EPO administer ed before dialysis on mortality in incident ESRD patients. A total of 4,866 patients whose exposure to pre-ESRD EPO was determined from Health Care Fi nancing Administration 2728 forms were analyzed. The median follow-up was 2 6.2 months, with 1,107 (22.7%) patients given EPO and 1,892 (38.9%) deaths. EPO use was more common in patients who had insurance before dialysis, rem ained employed, were started on renal replacement therapy outside the hospi tal, or initiated on peritoneal dialysis, which could be indicative of earl y intervention or quality care. The risk of death after starting dialysis w as lower for patients treated with EPO before dialysis compared with patien ts who were not treated (adjusted relative risk 0.80, 95% confidence interv al 0.70 to 0.91). There was no direct relationship between predialysis hema tocrit and mortality; however, the most significant survival benefit with E PO use was in patients with the highest hematocrit values (adjusted relativ e risk 0.67, 95% confidence interval, 0.51 to 0.89). The most significant e ffect of pre-ESRD EPO use was observed during the first 19 months after sta rting dialysis (adjusted relative risk, 0.81; 95% confidence interval, 0.71 to 0.91), but this benefit diminished in patients with longer follow-up on renal replacement therapy, Use of EPO before dialysis confers a survival b enefit to ESRD patients, especially in patients with an adequate hematocrit response before initiation of dialysis. (C) 2001 by the National Kidney Fo undation, Inc.