The cost-benefit of utilizing post-dialysis haemoglobin for dosing of erythropoiesis-stimulating agent therapy in patients with anaemia on haemodialysis in a low-resource setting

Abstract Background: Access to dialysis in South Africa is limited by budgetary constraints. Erythropoiesis-stimulating agents (ESAs) are used to manage anaemia in dialysis patients but are significant cost drivers. We aimed to evaluate haemoglobin and weight variation during dialysis and to assess whether using post-dialysis haemoglobin rather than pre-dialysis haemoglobin was associated with ESA dose reduction and cost benefit. Methods: In this single-centre cross-sectional study, haemoglobin and weight differences before and after a 4-hour mid-week maintenance haemodialysis session were compared. The ESA doses required to maintain haemoglobin levels within the recommended range of 10 – 11.5g/dL were calculated based on the pre- and post-dialysis haemoglobin results, and the difference was used to determine the cost benefit. Results: Fifty-five patients on chronic haemodialysis at a tertiary hospital in Johannesburg, South Africa, were enrolled. The mean post-dialysis haemoglobin was higher than pre-dialysis haemoglobin (11.34±1.75 vs 10.92±1.45g/dL, p=0.003), representing a 3.95% mean haemoglobin increase. The mean intradialytic weight reduction was 3.32±1.68%, p