Impact of Erythropoietin Administration during Hospitalization on Postdischarge Hemoglobin among Patients on Hemodialysis

Background: Hemoglobin(Hgb) concentration often decreases post hospital discharge among ESKD resulting from underlying cause of hospitalization, absence of erythropoietin (ESA) administration during hospitalization or inadequate dose of ESA. There is no standardized guideline for management of anemia in such patients. The management may include conservative monitoring, continuation of ESA, or blood transfusion. To achieve quality care and exact cost efficiency, we planned to give all hospitalized ESKD patients 10,000 units per week subcutanoeous. This dose was intended to maintain a level of ESA to prevent apoptosis and maintain Hgb. An analysis of the outcome follows. Methods: We undertook a retrospective review of the medical records of hemodialysis patients from a single satellite facility admitted to NYP Queens from January to December,2023. The following data was extracted: Serum Hgb at time of admission, duration of hospital stay, units of blood transfusion, ESA administration during hospitalization, and post discharge hemoglobin upon return to the dialysis facility. The outcome analyzed was post discharge Hgb stability, defined as maintenance of baseline Hgb or increased Hgb concentration. Fisher exact test was utilized for statistical analysis. The Impact on hemoglobin blood transfusion and length of hospital stay were similarly evaluated. All data was gathered and analyzed in an anonymous fashion Results: 78 patients met the inclusion criteria and have all the required laboratory parameters for review. 36 of these patients received ESA while 42, for unknown reasons, did not receive any ESA dose. This later group, effectively, served as an internal control. The data is displayed below as 2 x 2 tables with calculated P values. Conclusion: There was no benefit of ESA administration to patients with ESKD during hospitalization , irrespective of length of stay. We speculate that administration of ESA for short-term hospitalization may not be required, resulting in significant cost savings with no negative clinical impact. Further randomized, blinded, multi-dosing ESA trial for patients with ESKD during acute hospitalization may affirm our finding.