Abstract
Hemodialysis (HD) patients who are resistant to erythropoiesis-stimulating agents (ESAs) have a higher mortality rate. The aim of this study was to assess the relationship between the time-dependent variability of ESA response in HD patients and mortality. A total of 375 HD patients were enrolled in this study. The ESA resistance index (ERI) was calculated by dividing the weekly weight-adjusted ESA dose by hemoglobin concentration, and the average ERI was calculated from the ERI values every 2 months during a 36-month follow-up period. We divided the patients into six groups based on the patterns of their ERI level fluctuations: low-low (Low group), intermediate-intermediate (Intermediate group), high-high (High group), Low-intermediate group, Intermediate-high group, and Low-high group. There were 94 (25.1 %) deaths, and they included 51 (13.6 %) deaths from cardiovascular disease (CVD). A multivariate analysis with adjustment for age, serum albumin and C-reactive protein levels, and history of CVD showed that the High group was independently and significantly related to all-cause mortality (odds ratio = 5.53, 95 % CI 2.29–13.99, p = 0.0001) and CVD-related mortality (odds ratio = 3.49, 95 % CI 1.40–8.47, p = 0.0081). High ERI levels are an independent risk factor for all-cause and CVD mortality in HD patients.
Highlights
Hemodialysis (HD) patients who are resistant to erythropoiesis-stimulating agents (ESAs) have a higher mortality rate
Lopez-Gomez et al reported finding a relationship between ESA resistance in HD patients and 1-year mortality [4], and ESA resistance remained a significant predictor of mortality in HD patients [5, 6]
The time-dependent changes of ESA resistance index (ERI) has not examined, consistently high ESA resistance was expected to be an adverse effect on mortality of HD patients
Summary
Hemodialysis (HD) patients who are resistant to erythropoiesis-stimulating agents (ESAs) have a higher mortality rate. The aim of this study was to assess the relationship between the time-dependent variability of ESA response in HD patients and mortality. Erythropoiesis-stimulating agent (ESA) therapy has resulted in substantial health benefits for ESRD patients, including improved quality of life, a reduced need for blood transfusion, and greater exercise capacity [1]. After making adjustments for other variables, previous studies have shown that the need for ESA therapy is an independent predictor of all-cause mortality in HD patients [3]. The time-dependent changes of ESA resistance index (ERI) has not examined, consistently high ESA resistance was expected to be an adverse effect on mortality of HD patients. The aim of our study was to assess the presence of variability in the time
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