Continuous calcimimetic use with erythropoiesis-stimulating agent co-administration within a target hemoglobin range is associated with lower mortality in dialysis patients

Continuous use of calcimimetics may be associated with lower mortality in dialysis patients receiving ESAs, especially in those with higher EPO doses and certain risk factors.

Summary and findings

This study assessed the association between continuous calcimimetic use and all-cause mortality in dialysis patients receiving erythropoiesis-stimulating agents (ESAs). The study included 96 calcimimetic users and 270 non-users over a 2-year period. Results indicated lower mortality in calcimimetic users compared to non-users.

Abstract

<title>Abstract</title> <p> Hyporesponsiveness to erythropoietin (EPO)-stimulating agents (ESAs) is a risk factor for mortality. Because calcimimetics can improve ESA hyporesponsiveness, we conducted a retrospective propensity score-matched study comparing 2-year all-cause mortality in dialysis patients between continuous calcimimetic users (n = 96) and non-users (n = 270) receiving continuous ESA treatment within a target hemoglobin range. The term “continuous” was defined as the same condition persisting for the preceding 3 months. Survival was assessed using Kaplan–Meier survival curves with annual censoring for changes in calcimimetic and ESA use. Mortality was lower in calcimimetic users than in non-users after propensity score matching (P = 0.001, log-rank test). Subsequently, Cox proportional hazards regression analysis with adjustment for covariates that remained imbalanced following matching demonstrated lower mortality in calcimimetic users (adjusted hazard ratio, 0.226, 95% confidence interval 0.058–0.889, P = 0.033). Furthermore, stratified Kaplan–Meier analyses showed significantly lower mortality among calcimimetic users with an EPO equivalent dose ≥ 9,000 IU/week, age ≥ 68 years, cardiovascular disease history, body mass index < 20 kg/m ² , and high-sensitivity C-reactive protein ≥ 0.3mg/dL. These findings support the observation that continuous calcimimetic users had lower mortality than continuous non-users, especially in elderly patients characterized by high ESA doses, cardiovascular disease history, and weight loss or inflammation. </p>

Elsewhere in the Erythropoietin (EPO) corpus