Analyses from two databases—the U.S. Renal Data System (USRDS) and the Dialysis Outcomes and Practice Patterns Study (DOPPS)—reported similar findings at two separate sessions here.
Allan Collins, MD, of the University of Minnesota and director of the USRDS coordinating center, found that mean hemoglobin levels fell 3.8 percent between 2009 and the first nine months of 2011, from 11.39 g/dL to 10.96 g/dL.
The drop corresponded with a 19.2 percent drop in ESA doses and a 3.4 percent increase in use of IV iron during that time.
Though the data didn't show an increase in hospitalizations, researchers were concerned by the rise in blood transfusions, which had remained largely stable in 2009 and 2010. In September 2011, however, there were 0.036 transfusions per patient per month, compared with about 0.030 in that month for both prior years, a trend that accelerated after the ESA label changes.
The result could be a reduced likelihood of eligibility for kidney transplant, but there is no data yet to determine whether this has been the case: "How much it will decrease access is a complicated question," said Vassalotti, who chaired the session during which the USRDS data were presented.
He added that the transfusion rates seen in the study may be underreported because the dialysis centers included in the surveillance system may not necessarily keep accurate tabs on the number of patients hospitalized outside of their centers for transfusion.
Data from DOPPS, an international 12,000-patient dataset that tracks 140 U.S. dialysis facilities and about 5,000 U.S. patients, revealed similar trends, although it did notice an uptick in hospitalizations.