Abstract Background: Access to dialysis in South Africa is limited by budgetary constraints. Erythropoiesis-stimulating agents (ESAs) are used to manage anaemia in dialysis patients but are significant cost drivers. We aimed to evaluate haemoglobin and weight variation during dialysis and to assess whether using post-dialysis haemoglobin rather than pre-dialysis haemoglobin was associated with ESA dose reduction and cost benefit. Methods: In this single-centre cross-sectional study, haemoglobin and weight differences before and after a 4-hour mid-week maintenance haemodialysis session were compared. The ESA doses required to maintain haemoglobin levels within the recommended range of 10 – 11.5g/dL were calculated based on the pre- and post-dialysis haemoglobin results, and the difference was used to determine the cost benefit. Results: Fifty-five patients on chronic haemodialysis at a tertiary hospital in Johannesburg, South Africa, were enrolled. The mean post-dialysis haemoglobin was higher than pre-dialysis haemoglobin (11.34±1.75 vs 10.92±1.45g/dL, p=0.003), representing a 3.95% mean haemoglobin increase. The mean intradialytic weight reduction was 3.32±1.68%, p<0.0001. The calculated median ESA dose based on post-dialysis haemoglobin was significantly lower than the ESA dose based on the pre-dialysis haemoglobin (6,000 (IQR 0-12 0000) vs 8,000 (IQR 4,000-12,000) IU/week, p<0.0001). The difference in ESA dose translated into a mean cost saving of 21.38%. Conclusion: In an environment where dialysis access is limited by resource constraints, ESA dosing based on post-dialysis haemoglobin concentrations may translate into significant cost savings. Larger studies are required to validate this approach and assess long-term patient outcomes.
Makins et al. (2026) studied this question.