Mortality risk in hemodialysis patients according to anemia control and erythropoietin dosing Paulo Roberto SANTOS, Antonio Danilo Mourão MELO, Monique Marie Brito Cortez LIMA, Idalina Maria A. Holanda NEGREIROS, Jéssica Silva MIRANDA, Larissa Salles PONTES, Guilherme Menezes RABELO, Ana Carolina Parente VIANA, Mayara Teixeira ALEXANDRINO, Francisco Anderson BARROS, Benjamin Ramos NETO, Alana Alcântara BRITO, Anderson DA SILVA COSTA Sobral School of Medicine, Federal University of Ceará, Sobral, Brazil Abstract There is no consensus about the toxicity of erythropoiesis-stimulating agents among hemodialysis patients. We aimed to calculate the risk of death according to anemia control and erythropoietin (EPO) dosing among end-stage renal disease patients undergoing hemodialysis. We retrospectively studied 156 end-stage renal disease patients on hemodialysis from a single renal unit during 12 months. Participants were classified according to anemia control into four groups: excellent (A), good (B), moderate (C) and bad (D) control. They were also classified according to EPO dosing into two groups: usual and high EPO dosing. The Cox proportional hazards regression model, adjusted for the difference in age, sex, time on dialysis, comorbidity, albumin, and Kt/V index, was performed to calculate the risk of death according to anemia control and EPO dosing profiles. Multivariate analysis by backward stepwise logistic regression was used to calculate the risk of death according to the variables that differed in the comparison between survivors and nonsurvi- vors. The hazard ratio of death was not significant according to anemia control profile C/D vs. A/B, but hazard ratio was 2.967 (95% confidence interval [CI] = 1.132–7.777; P = 0.027) for high EPO dosing profile patients. The multivariate analysis showed comorbidity (odds ratio [OR] = 8.958; 95% CI = 2.843–26.223; P < 0.001], high EPO dosing profile (OR = 5.172; 95% CI = 1.663–16,081; P = 0.005), age (OR = 1.056; 95% CI = 1.020–1.094; P = 0.002), and mean hemoglobin (OR = 0.435; 95% CI = 0.267–0.709; P = 0.001) to be predictive of death. Even though we cannot conclude that mortality risk is due to EPO toxicity, hemodialysis patients using high EPO dosing must be seen as at risk. Key words: anemia, end-stage kidney disease, erythropoietin, hemodialysis INTRODUCTION Anemia is a usual complication in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Before the 1990s, HD anemic patients were submitted to ineffi- cient treatment by blood transfusions and the administra- Correspondence to: P. R. Santos, PhD, Rua Tenente Amauri Pio, 380 apt. 900, CEP 60.160-090, Fortaleza, CE, Brazil. E-mail: prsantos@fortalnet.com.br Hemodialysis International 2011; 15:493–500 © 2011 The Authors Hemodialysis International © 2011 International Society for Hemodialysis DOI:10.1111/j.1542-4758.2011.00607.x 493