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Daniel W. Coyne, MD

JAMA. 2007;297:1713-1716.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In this issue of JAMA, Thamer and colleagues¹ examine the use of epoetin in US dialysis facilities. This report comes at an opportune time given the recent US Food and Drug Administration (FDA) advisory warning that epoetin and darbepoetin (erythropoiesis-stimulating agents [ESAs]) result in "an increased number of deaths and of non-fatal heart attacks, strokes, heart failure, and blood clots when ESAs were adjusted to maintain . . . hemoglobin more than 12 g/dL."² The FDA recommends using just enough ESA to maintain the lowest hemoglobin level necessary to avoid the need for transfusions and ensure hemoglobin level does not exceed 12 g/dL.² The data from Thamer and colleagues¹ suggest higher epoetin use was the goal, and targeting higher hemoglobin levels was the means to that goal.

Thamer et al¹ report that for-profit facilities administer about 3300 U/wk more epoetin per patient than nonprofit facilities. The 2004 reimbursement rate . . . [Full Text of this Article]

Author Affiliation: Washington University School of Medicine, St Louis, Mo.

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