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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Anemia is common in hemodialysis (HD) patients and is mainly treated with erythropoiesis-stimulating agents (ESAs) to maintain hemoglobin (Hb) levels between 10 and 11.5 g/dL. Hb variability has been associated with adverse clinical outcomes. One potential contributor to Hb variability is frequent or excessive adjustments of ESA doses. We examined how the magnitude of ESA dose adjustments relates to short-term Hb target attainment and subsequent Hb variability.
We conducted a retrospective study of HD patients on rHuEPO who had been on maintenance HD for at least 3 months between September 2016 and August 2025 at King Chulalongkorn Memorial Hospital, Thailand. For each monthly measurement, Hb level and ESA dose were recorded. ESA adjustments were categorized into five groups: no change (0%), ≤15%, 15–30%, 30–50%, and >50% change from the previous month. The primary outcome was next-month Hb response (ΔHb 0.5–1.5 g/dL). Secondary outcomes included target attainment (10–11.5 g/dL) and within-patient Hb variability (residual SD).
We included 92 HD patients. rHuEPO used was epoetin alpha (52%) and epoetin beta (48%). We analyzed 3,211 monthly Hb measurements; the median Hb was 11.2 g/dL (IQR 10.4–11.9 g/dL), with 45% within the target range. The mean within-patient residual SD was 1.03 g/dL. The median ESA dose was 5000 IU per week (IQR 4000–8000 IU), and the median IV iron dose was 100 mg per month (IQR 0–200 IU). Among Hb measurements with previously stable Hb and stable ESA and iron dosing, when Hb was <10 g/dL, there was no significant difference in achieving the next-month Hb target between 15–30% and 30–50% ESA dose adjustments (49% vs. 45%). However, overshooting (>11.5 g/dL) within the following 3 months occurred more frequently in the 30–50% group (25.8% vs. 15.5%). Among patients with Hb >11.5 g/dL, better achievement of the next-month target was observed with a 0–15% dose reduction compared to 15–30% or 30–50% reductions (40% vs. 28% vs. 25%), with no significant difference in the proportion developing Hb <10 g/dL within the next 3 months. The effect of ESA dose reduction when Hb >11.5 g/dL persisted beyond one month, with a median time to Hb nadir of 56 days (IQR 33–91). Additionally, when Hb ranged from 9.74 to <10 g/dL, 48% returned to target without ESA modification; when Hb ranged from 11.5 to 11.74 g/dL, 40% returned without modification.
In HD patients, Hb variability was substantial, with fewer than half of monthly values within the target. Larger ESA adjustments did not improve short-term target attainment compared with moderate changes. The effect of ESA modification—particularly dose reductions—often extend beyond one month. Patients near the target frequently returned to range without intervention, supporting cautious, moderate ESA titration and avoiding unnecessary dose changes to reduce variability and improve long-term anemia management.
