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August 22/29, 2007

Epoetin Dosing and Dialysis Facility Ownership

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(8):861-863. doi:10.1001/jama.298.8.862-a

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.