Inpatient Erythropoiesis-Stimulating Agent Use and Anemia-Related Outcomes in Patients With Advanced Chronic Kidney Disease

Inpatient erythropoiesis-stimulating agent (ESA) management varies across institutions and is often influenced by system-level prescribing constraints, but the clinical impact of ESA interruption during hospitalization is unclear. This study evaluated anemia-related outcomes associated with shorter vs longer durations of inpatient ESA interruption in hospitalized patients with chronic kidney disease (CKD) in the setting of an electronic order entry restriction. This retrospective cohort study included hospitalized adult patients receiving ESA treatment prior to admission for anemia of CKD. Patients were grouped by duration of inpatient ESA interruption. The primary outcome was packed red blood cell (PRBC) transfusion during hospitalization. Secondary outcomes included hemoglobin (Hgb) below 7 g/dL, rehospitalization for anemia, bleeding, and mortality within 90 days post-discharge, time to transfusion, and hospital length of stay. Seventy-four patients met inclusion criteria. A higher proportion of patients with ≥10 days of ESA interruption required PRBC transfusion compared to those with <10 days (72.0% vs 54.2%, P = 0.13). Similar patterns were observed across other anemia-related outcomes, including Hgb <7 g/dL, rehospitalization for anemia, bleeding, and mortality. Time to transfusion was longer and hospital length of stay was greater in the ≥10-day group. These differences did not reach statistical significance. Longer inpatient interruption of ESA therapy was associated with consistent trends toward increased transfusion use and greater anemia burden among patients with CKD. Variation in inpatient ESA management, including system-level prescribing constraints, may influence anemia-related outcomes in this population and warrants further study.