Perez-Garcia R, et al. - The associations of mortality and hospitalization with erythropoiesis-stimulating agent (ESA) dose or the typology of the patient were investigated in haemodialysis (HD) patients given the issue of ESA safety has been raised in multiple studies, with correlates derived for elevated cancer incidence and mortality. ESA administration was according to standard medical practice and patients were grouped as quintiles, according to ESA dose. ESA doses of >8000 IU/week were shown to be related to an increased risk of all-cause mortality and hospitalization in HD patients.

• Researchers assessed the impacts of weekly ESA dose in 1679 incident haemodialysis (HD) patients via a multicentre, observational retrospective propensity score-matched study.
• Patients were administered ESA according to standard medical practice and were grouped as quintiles, according to ESA dose, in order to compare mortality and hospitalization data.
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• They used propensity score matching (PSM) and defined two groups of 324 patients receiving weekly threshold ESA doses of either > or ≤8000 IU.

• In patients administered with high doses of ESAs (>8127.4 IU/week), significant increases in the risk of mortality were shown by Kaplan–Meier survival curves.
• Using multivariate Cox models, a high ESA dose was identified as an independent predictor for all-cause and cardiovascular (CV) mortality.
• In logistic regression models, high ESA doses were noted to be independent predictor for all-cause, CV and infectious hospitalization.
• By PSM analyses, weekly ESA doses of >8000 IU were confirmed to constitute an independent predictor of all-cause mortality and hospitalization, even though the adjusted cohort displayed the same demographic features, inflammatory profile, clinical HD parameters and haemoglobin levels.