Erythropoietin Dose and Mortality in Hemodialysis Patients: Marginal Structural Model to Examine Causality
Joint Authors
Arah, Onyebuchi A.
Kalantar-Zadeh, Kamyar
Streja, Elani
Park, Jongha
Chan, Ting-Yan
Lee, Janet
Soohoo, Melissa
Rhee, Connie M.
Source
International Journal of Nephrology
Issue
Vol. 2016, Issue 2016 (31 Dec. 2016), pp.1-8, 8 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2016-05-19
Country of Publication
Egypt
No. of Pages
8
Main Subjects
Abstract EN
It has been previously reported that a higher erythropoiesis stimulating agent (ESA) dose in hemodialysis patients is associated with adverse outcomes including mortality; however the causal relationship between ESA and mortality is still hotly debated.
We hypothesize ESA dose indeed exhibits a direct linear relationship with mortality in models of association implementing the use of a marginal structural model (MSM), which controls for time-varying confounding and examines causality in the ESA dose-mortality relationship.
We conducted a retrospective cohort study of 128 598 adult hemodialysis patients over a 5-year follow-up period to evaluate the association between weekly ESA (epoetin-α) dose and mortality risk.
A MSM was used to account for baseline and time-varying covariates especially laboratory measures including hemoglobin level and markers of malnutrition-inflammation status.
There was a dose-dependent positive association between weekly epoetin-α doses ≥18 000 U/week and mortality risk.
Compared to ESA dose of <6 000 U/week, adjusted odds ratios (95% confidence interval) were 1.02 (0.94–1.10), 1.08 (1.00–1.18), 1.17 (1.06–1.28), 1.27 (1.15–1.41), and 1.52 (1.37–1.69) for ESA dose of 6 000 to <12 000, 12 000 to <18 000, 18 000 to <24 000, 24 000 to <30 000, and ≥30 000 U/week, respectively.
High ESA dose may be causally associated with excessive mortality, which is supportive of guidelines which advocate for conservative management of ESA dosing regimen in hemodialysis patients.
American Psychological Association (APA)
Streja, Elani& Park, Jongha& Chan, Ting-Yan& Lee, Janet& Soohoo, Melissa& Rhee, Connie M.…[et al.]. 2016. Erythropoietin Dose and Mortality in Hemodialysis Patients: Marginal Structural Model to Examine Causality. International Journal of Nephrology،Vol. 2016, no. 2016, pp.1-8.
https://search.emarefa.net/detail/BIM-1106351
Modern Language Association (MLA)
Streja, Elani…[et al.]. Erythropoietin Dose and Mortality in Hemodialysis Patients: Marginal Structural Model to Examine Causality. International Journal of Nephrology No. 2016 (2016), pp.1-8.
https://search.emarefa.net/detail/BIM-1106351
American Medical Association (AMA)
Streja, Elani& Park, Jongha& Chan, Ting-Yan& Lee, Janet& Soohoo, Melissa& Rhee, Connie M.…[et al.]. Erythropoietin Dose and Mortality in Hemodialysis Patients: Marginal Structural Model to Examine Causality. International Journal of Nephrology. 2016. Vol. 2016, no. 2016, pp.1-8.
https://search.emarefa.net/detail/BIM-1106351
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1106351