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Last updated on 02 Jan 2009

Renal Anaemia in the news

Black dialysis patients may need more EPO than whites

02 January 2009
Reuters Health

NEW YORK (Reuters Health) - In order to achieve similar hemoglobin levels, black patients undergoing hemodialysis require higher doses of erythropoietin (EPO) than do their white counterparts, Massachusetts-based researchers report in the December issue of the American Journal of Kidney Diseases.

"Further study," lead investigator Dr. Eduardo Lacson Jr. told Reuters Health, "is needed to elucidate biological or other mechanisms associated with racial differences to explain our findings."

Dr. Lacson and colleagues at Fresenius Medical Care, North America, Waltham, studied data on more than 44,000 patients who received dialysis 3 times weekly in their organization's facilities.

The team investigated EPO usage in this group in the month of January 2004. Medicare was the primary payer; 57% of the patients were white and 43% were black.

Black patients received 12.6% more EPO than white patients, while the hemoglobin levels achieved were similar. The disparity was most significant in patients aged 45 years or younger and 65 years or older.

In addition, 6% of black patients were in the group receiving the highest EPO dosage (more than 60,000 U per week) compared to only 4% of white patients.

As well as having possible biological implications, continued Dr. Lacson, the findings may also have economic consequences.

"If EPO use is included in a prospective 'bundle' reimbursement system such as the one being considered by the Centers for Medicare & Medicaid Services," he concluded, "it will become a much larger expense for facilities that serve a predominantly African American population -- such that racial distribution of the beneficiary population may need to be a consideration."

Commenting on the findings in an accompanying editorial, Dr. James S. Kaufman of Boston University School of Medicine observes that the meager understanding of the biological mechanisms involved makes "the design of an evidence-based reimbursement policy fraught with difficulty."

Am J Kidney Dis 2008;52:1104-1114.