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.
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