Learn about the
2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com: What are the main findings of the study?

We have carried out a retrospective database analysis of missed dialysis sessions among end-stage renal disease patients within a large dialysis organization in the US.

The mean number of missed dialysis sessions per patient-month was approximately one. Missed sessions were found to result in increases in per-session ESA dose when the patient returned to dialysis.

Longer missed session episodes were associated with greater per-session ESA dose increases, and dose increases were sustained up to 60 days following return to dialysis.

In addition, for months in which patients missed up to six dialysis sessions, total ESA doses were higher than for months in which patients attended every session.

Hemodialysis.com: Were any of the findings unexpected?

The fact that total monthly ESA dose was higher for months in which up to 6 sessions were missed than in months in which all sessions were attended is surprising. As patients are missing dialysis sessions at which ESAs would normally be dosed, it might be expected that patients would receive reduced lower overall monthly doses.

However, the persistent increase in per-session doses on return to dialysis more than compensates for this reduction, and total monthly doses are actually higher when sessions are missed.

Hemodialysis.com: What should clinicians and patients take away from your report? 

Missed dialysis sessions result in increases in ESA use on a per-session basis when the patient returns to dialysis, and also in increased total monthly ESA dose.

Hemodialysis.com : What recommendations do you have for future research as a result of this study?  

Increases in ESA use following missed sessions should be considered in any future assessment of the impact of missed sessions, clinical or economic.

Reference:

International Congress on Renal Nutrition and Metabolism 2012

Presenting author: T. Christopher Bond, PhD
ERYTHROPOIESIS STIMULATING AGENT (ESA) USE IS INCREASED FOLLOWING MISSED DIALYSIS SESSIONS
T. Christopher Bond1, Jaime Rubin1, Steven Wang1, Alex Yang2
1DaVita Clinical Research, Minneapolis, MN, USA; 2Affymax, Palo Alto, CA, USA