Erythropoietin Dose and Mortality in Hemodialysis Patients: Marginal Structural Model to Examine Causality.

摘要: It has been previously reported that a higher erythropoiesis stimulating agent (ESA) dose in hemodialysis patients is associated with adverse outcomes including mortality; however the causal relationship between ESA and mortality still hotly debated. We hypothesize indeed exhibits direct linear models of association implementing use marginal structural model (MSM), which controls for time-varying confounding examines causality dose-mortality relationship. conducted retrospective cohort study 128 598 adult over 5-year follow-up period to evaluate weekly (epoetin-α) risk. A MSM was used account baseline covariates especially laboratory measures hemoglobin level markers malnutrition-inflammation status. There dose-dependent positive epoetin-α doses ≥18 000 U/week Compared <6 000 U/week, adjusted odds ratios (95% confidence interval) were 1.02 (0.94-1.10), 1.08 (1.00-1.18), 1.17 (1.06-1.28), 1.27 (1.15-1.41), 1.52 (1.37-1.69) 6 000 <12 000, 12 000 <18 000, 18 000 <24 000, 24 000 <30 000, ≥30 000 U/week, respectively. High may be causally excessive mortality, supportive guidelines advocate conservative management dosing regimen patients.