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To the Editor: Dr Thamer and colleagues¹ found higher utilization of erythropoiesis-stimulating agents (ESAs) in certain dialysis chains, especially the for-profit ones. Both this article and the accompanying Editorial by Dr Coyne² speculated about the possible reasons for this and emphasized that higher ESA doses and hemoglobin levels above the Food and Drug Administration–recommended target range of 10 g/dL to 12 g/dL may not offer survival advantages and may even be harmful. The survival of dialysis patients in the different dialysis chains was not compared, nor was there any examination of the association between ESA utilization or hemoglobin level and mortality at chain level.

Generalizing findings of observational studies, and singling out ours,³ Coyne states that "observational studies have noted that higher hemoglobin levels correlate with . . . better survival in dialysis patients" and that they are "seriously confounded by the interrelationship of anemia and epoetin resistance with illness in patients with chronic . . . [Full Text of this Article]

Deborah L. Regidor, MPH; Kamyar Kalantar-Zadeh, MD, PhD, MPH
kamkal@ucla.edu
Harbor-UCLA Medical Center
Torrance, California

Csaba P. Kovesdy, MD
Salem VA Medical Center
Salem, Virginia

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