While discontinuation was associated with a higher likelihood of dropping to a hemoglobin level below 10 g/dl, this occurred in relatively few individuals. Factors associated with a drop in hemoglobin level to below 10 g/dl included higher baseline epoetin dose and elevated blood markers of inflammation. After adjusting for these factors, patients who discontinued epoetin were 1.91 times more likely to have a lowest hemoglobin level below 10 g/dl. In contrast, patients who reduced epoetin were 4.41 times as likely to have a lowest hemoglobin level above 12 g/dl.

These results indicate that once a patient reaches a hemoglobin level of 13 g/dl or higher, discontinuing epoetin is more likely to lower the hemoglobin level to within the recommended range compared with reducing the dose of epoetin. However, discontinuing epoetin also increases the patient's risk of developing a lower-than-recommended hemoglobin level, while reducing epoetin is associated with significantly increased time at a higher-than-recommended hemoglobin level.

The major limitations of the study were the use of administrative data in a retrospective fashion, and the lack of hard outcome data, including mortality.

Source : Clinical Journal of the American Society Nephrology