Estimated Effect of Epoetin Dosage on Survival among Elderly Hemodialysis Patients in the United States

BACKGROUND AND OBJECTIVES: The common finding that low achieved hemoglobin in observational studies and high target hemoglobin in randomized trials each were associated with increased mortality and high epoetin dosage has suggested the possibility that high epoetin dosage might explain the increased mortality risk. DESIGN, SETTING, PARTICIPANTS, 95% confidence interval CI) was 0.90 (0.52 to 1.54) for 40,000 U/wk. In contrast, conventional unweighted models, which do not adequately adjust for time-dependent confounding by indication, indicated an association between high cumulative average epoetin dosage and increased mortality. CONCLUSIONS: Our findings suggest that, on average, epoetin dosages >30,000 U/wk do not confer additional harm or benefit in elderly hemodialysis patients.