Epoetin use and Kidney Disease Outcomes Quality Initiative hemoglobin targets in patients returning to dialysis with failed renal transplants

Patients with failed renal transplants represent an increasing proportion of the current dialysis population. Although their risk of anemia might be expected to be high, whether these patients receive adequate anemia therapy after returning to dialysis is unknown. We studied intravenous iron use, epoetin doses, and hemoglobin levels in patients with and without failed renal transplants who survived for 6 months after initiation of dialysis in the United States between 1996 and 2001. Of the study population (n=220 557), 9922 (4.5%) had failed renal transplants. In spite of a greater likelihood of receiving intravenous iron therapy (adjusted odds ratio (AOR) 1.47, P<0.0001) and epoetin (AOR 1.57, P<0.0001), patients with failed transplants were more anemic and had higher epoetin doses in each month of follow-up. During month 6, patients with failed transplants were more likely to have hemoglobin levels below 11 g/dl (AOR 1.50, P<0.0001) and to have epoetin-to-hemoglobin ratios above the population median of 1030 U/week per g/dl (AOR 1.73, P<0.0001). Patients who return to dialysis with failed transplants are at a higher risk of anemia than other patients who start dialysis; the pattern of lower hemoglobin levels and higher ratios of epoetin-to-hemoglobin suggests that relative epoetin resistance may be contributory.