Impact of gender and dialysis adequacy on anaemia in peritoneal dialysis

Alicja Ryta,Malgorzata Sikorska-Wisniewska,Monika Lichodziejewska-Niemierko,Piotr Jagodzinski,Michal Chmielewski,Alicja Debska-Slizien

doi:10.1007/s11255-016-1499-1

Alicja Ryta, Malgorzata Sikorska-Wisniewska + Show 4 more

Open Access

https://doi.org/10.1007/s11255-016-1499-1

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Abstract

PurposeIn the general population, haemoglobin (Hb) concentration is higher in men than in women. However, target Hb levels in dialysis patients are set constant regardless of the patient’s sex. The aim of this study was to evaluate Hb concentration and the use of erythropoiesis-stimulating agents (ESA) in peritoneal dialysis (PD) patients taking gender and dialysis adequacy into account.MethodsThe study comprised two parts. The first was a cross-sectional analysis of Hb and ESA in 2180 prevalent PD patients. The second included 88 incident PD patients, followed for 36 months. During this time, the major parameters recorded at 12-month intervals included: Hb concentration, weekly ESA, total, renal, and peritoneal Kt/V. Erythropoietin resistance index (ERI) was calculated as the ratio between ESA dose and achieved Hb.ResultsIn prevalent PD patients, Hb concentration was significantly lower in women, (11.2 ± 1.4 vs. 11.5 ± 1.6 g/dl; p < 0.001), despite higher doses of ESA (2691 ± 1821 vs. 2344 ± 1422; p = 0.001). Hb concentrations were related to dialysis adequacy in both cohorts. However, despite significantly higher Kt/V, women were characterized by a lower Hb level. In incident patients, this association was present throughout the observation period, while the ESA dose in women was significantly higher at every time point. In multiple regression analysis, gender was an independent determinant of ERI (b = 0.34; p < 0.05).ConclusionsDespite higher dialysis adequacy, Hb concentration in women treated with PD is significantly lower, and the ability to correct it impaired, as compared to men.

Highlights

Anaemia is a constant complication of end-stage renal disease (ESRD)
This was a cross-sectional evaluation of Hb concentration and erythropoiesis-stimulating agents (ESA) dose in men and women treated with peritoneal dialysis (PD)
The cross-sectional evaluation of the data from the national PD Registry was based on 2180 prevalent PD patients

Summary

Introduction

Anaemia is a constant complication of end-stage renal disease (ESRD). Driven mainly by a relative deficit in erythropoietin, it has an important impact on patient’s physical condition and quality of life. The target haemoglobin (Hb) concentrations are set constant, regardless of the patient’s sex [1] This stays in contrast to the situation in the general population where Hb level is typically higher in men than in women. Women are considered to be anaemic if their haemoglobin is less than 11.5 or 12.0 g/dl, while in males the threshold is set at 13.0 or 13.5 g/dl [2] These gender-associated disparities in Hb concentration are believed to be due to several factors including sex hormones, iron deficiency due to menstrual losses, and perhaps poor nutritional intake [2]. These factors are, to some extent, absent in peritoneal dialysis (PD) patients.

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