Clin Ther. 2026 Oct 19:S0149-2918(26)00355-3. doi: 10.1016/j.clinthera.2026.10.001. Online ahead of print.
ABSTRACT
PURPOSE: Epoetin alfa labeling and clinical guidelines recommend weight-based dosing for the management of patients with anemia and chronic kidney disease (CKD). However, fixed dosing continues to be used in inpatient practice, and comparative data in hospitalized populations are limited. This study aimed to compare fixed versus weight-based dosing in hospitalized patients with CKD.
METHODS: This retrospective cohort study included hospitalized adult patients with anemia of CKD who were initiated on epoetin alfa at a large academic medical center between January 2014 and August 2024. The primary outcome was hemoglobin exceeding targets (>10 g/dL for non-dialysis-dependent CKD and >11 g/dL for dialysis-dependent CKD). Secondary outcomes included 90-day all-cause mortality, rehospitalization, major adverse cardiovascular events, packed red blood cell transfusion, new or worsening hypertension, and iron deficiency.
FINDINGS: Among 100 patients (50 in the fixed-dose group and 50 in the weight-based dose group), hemoglobin exceeded targets in 8% and 4% of patients, respectively (P = 0.678). Ninety-day all-cause mortality occurred in 18% and 4% of patients, respectively (P = 0.160); no statistically significant differences were observed in other secondary outcomes. Fixed-dose regimens resulted in higher weight-normalized epoetin alfa doses than weight-based dosing (119.8 vs 67.1 units/kg; P < 0.001).
IMPLICATIONS: Among hospitalized patients with CKD, fixed-dose epoetin alfa was associated with substantially higher weight-normalized doses and numerically higher rates of hemoglobin exceeding targets and mortality, though differences in clinical outcomes were not statistically significant. These findings suggest that adherence to guideline-recommended weight-based dosing may minimize excessive epoetin alfa dosing. Larger prospective studies are needed to clarify optimal inpatient erythropoiesis-stimulating agent dosing.
PMID:42897033 | DOI:10.1016/j.clinthera.2026.10.001