The impact of end-stage renal disease transfusion demand on blood utilization and blood supply in the United States

BACKGROUND: Excess supply of blood is required to ensure availability to patients requiring transfusions at the time of need. End-stage renal disease (ESRD) patients undergoing dialysis account for a substantial portion of the demand for transfusions. OBJECTIVE: The purpose of this analysis was to explore the impact of ESRD transfusion demand on the US blood supply and its margin. METHODS: A mathematical model was developed to evaluate the impact on the overall US demand for blood transfusions associated with changes in the mean hemoglobin (Hb) among ESRD patients at Hb levels ranging from 9 to 12 g/dL. RESULTS: Our results suggested that, based on ESRD prevalence and blood supply estimates and a mean population Hb of 12 g/dL, 27,845 dialysis patients would receive an estimated total of 17,384 units of blood, compared with an estimated 123,503 dialysis patients receiving a total of 288,590 units of blood at a mean population Hb level of 9 g/dL. Based on an assumed supply margin of 10%, our model estimated that approximately 21.9% of this margin would be utilized by ESRD patients with a mean population Hb of 9 g/dL, compared with 8.7% for mean Hb of 10 g/dL, 3.0% for mean Hb of 11 g/dL, and 1.3% for mean Hb of 12 g/dL. CONCLUSIONS: Potential changes in treatment practices for ESRD may shrink the blood margin and limit availability of blood products for other uses, such as for acute injuries and surgical procedures.