Abstract
BackgroundIt is known that one of the leading causes of morbidity in chronic kidney disease (CKD) is the anemic syndrome. Although the pathogenic mechanisms of anemia are multiple, erythropoietin deficiency appears as the dominant factor. Patients in hemodialysis (HD) have a high prevalence of protein energy wasting (PEW) that may explains the poor response to Erythropoietin (EPO).MethodsRetrospective cohort study of patients on HD from January to December 2014. The participants were classified according to a diagnostic of PEW using the “Malnutrition Inflammation Score” (MIS) and bioimpedance analysis (BIA) measurement of body composition at the start of erythropoietin therapy and after 3 months of follow up. We performed descriptive statistics and analyzed the differences between groups with and without PEW considering their responsiveness. In addition, we calculated the relative risk of EPO resistance, considering p value < 0.05 as statistically significant.ResultsSixty-one patients ended the follow up. Both groups were similar in basal hemoglobin, hematocrit and other hematopoiesis markers (p = NS). Patients without PEW have a decrease risk for poor response to treatment with EPO (RR = 0.562 [95% CI, 0.329–0.961-]) than those with PEW. Finally, hemoglobin concentrations were evaluated at baseline and every four weeks until week 12, finding a statistically significant improvement only in patients without PEW according MIS (p < 0.05).ConclusionsPEW is an incremental predictor of poor responsiveness to EPO in HD patients, thus, it is important to consider correcting malnutrition or wasting for a favorable response to treatment with EPO.
Highlights
It is known that one of the leading causes of morbidity in chronic kidney disease (CKD) is the anemic syndrome
Since a 2% increase in the Hb concentration is likely to be within the variability range of Hb values in individual patients, this value is considered as no increase.The erythropoiesis stimulating agents (ESA) responsiveness index (ERI) was defined as the weekly weight-adjusted EPO dose (U/kg/week) divided by the hemoglobin level (g/dL) and calculated monthly to investigate resistance to EPO treatment [11]
Per definition of the two groups, statistically significant differences were found between the two groups in variables associated with nutritional status such as weight, body mass index (BMI), serum creatinine, serum albumin and potassium we found that the patients with protein energy wasting (PEW) had a higher ERI (IU/kg/week) (p = 0.04)
Summary
It is known that one of the leading causes of morbidity in chronic kidney disease (CKD) is the anemic syndrome. One of the leading causes of morbidity in patients with advanced chronic kidney disease (CKD) is the presence of anemia. There are several pathogenic mechanisms for anemia in the CKD patient, Erythropoietin (EPO). Definition of poor response In general, in most practice guidelines, the recommended range of Hb is 10-12 g/dl [5] To reach this level, it is generally sufficient to administer initial doses of 50–150 Units/kilogram/week (U/kg/week) and maintenance doses of 40 U/kg/week, as long as a proper iron store are assured in the patient [8, 9]. Since a 2% increase in the Hb concentration is likely to be within the variability range of Hb values in individual patients, this value is considered as no increase.The ESA responsiveness index (ERI) was defined as the weekly weight-adjusted EPO dose (U/kg/week) divided by the hemoglobin level (g/dL) and calculated monthly to investigate resistance to EPO treatment [11]
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