Abstract
Anemia is an inevitable complication of hemodialysis, and the primary cause is erythropoietin deficiency. After diagnosis, treatment begins with an erythropoiesis-stimulating agent (ESA). However, some patients remain anemic even after receiving this medication. This study aimed to investigate the factors associated with resistance to recombinant human erythropoietin therapy with epoetin alfa (αEPO). We performed a prospective, longitudinal study of hemodialysis patients receiving treatment with αEPO at our reference hospital from July 2015 to June 2016. Clinical data was collected, and the response to αEPO treatment was evaluated using the erythropoietin resistance index (ERI). The ERI was defined as the weekly weight-adjusted αEPO dose (U/kg per week)/hemoglobin level (g/dL). A longitudinal linear regression model was fitted with random effects to verify the relationships between clinical and laboratory data and ERI. We enrolled 99 patients (average age, 45.7 (±17.6) years; male, 51.5%; 86.8% with hypertension). The ERI showed a significant positive association with serum ferritin and C-reactive protein, percentage interdialytic weight gain, and continuous usage of angiotensin receptor blocker (ARB) hypertension medication. The ERI was negatively associated with serum iron and albumin, age, urea reduction ratio, and body mass index. Our findings indicate that resistance to αEPO was related to a low serum iron reserve, an inflammatory state, poor nutritional status, and continuous usage of ARBs.
Highlights
Anemia commonly complicates the last stage of chronic kidney disease (CKD) and is associated with increased morbidity and mortality and a decreased quality of life in dialysis patients [1,2]
The correction of anemia in patients with CKD requires the use of erythropoiesis-stimulating agents (ESAs) such as epoetin alfa
In the non-adjusted regression model, we found that the erythropoietin resistance index (ERI) was negatively associated with age, urea reduction ratio (URR) %, body mass index (BMI), serum iron, and serum albumin
Summary
Anemia commonly complicates the last stage of chronic kidney disease (CKD) and is associated with increased morbidity and mortality and a decreased quality of life in dialysis patients [1,2]. Several factors contribute to the development of anemia in patients with CKD, including nutritional deficiencies, an inflammatory state, and blood losses related to the dialysis procedure. The correction of anemia in patients with CKD requires the use of erythropoiesis-stimulating agents (ESAs) such as epoetin alfa (aEPO). While anemia correction significantly improves patient quality of life and reduces mortality rates [2,9,10,11], the response of hemodialysis patients to ESA treatment varies, and hyporesponsiveness or resistance to ESA therapy occurs in 5–10% of patients with CKD [12,13]
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