Biology Agriculture Aquaculture Horticulture Postharvest Forestry Geography Environment Health





Hyporesponsiveness to erythropoiesis-stimulating agents and renal survival in non-dialysis CKD patients

submitted by crazmeis 1 year and 9 months ago
Lower responsiveness to erythropoiesis-stimulating agents (ESA-R) predicts cardiovascular (CV) events. Whether ESA-R also affects the risk of end-stage renal disease (ESRD) is unknown. We evaluated ESA-R in 194 consecutive chronic kidney disease (CKD) patients, regularly seen in outpatient nephrology clinics, who started erythropoiesis-stimulating agent (ESA) therapy between 22–6. Exclusion criteria were causes of anaemia other than CKD or recent transfusion. ESA-R was calculated as (Hb1 – Hb)/time/ESA dose (g/dL/month/1 μg/week of ESA). Patients were classified, from lower to higher tertile of ESA-R, as poor, intermediate and good responders. Time to ESRD was the primary outcome. Age was 64 ± 16 years, 48% were male, 34% had diabetes and 32% had CV disease, glomerular filtration rate (GFR) 24 ± 13 mL/min/1.73 m2 and proteinuria .6 g/dL (interquartile range .2–1.9). First ESA dose was 23.7 ± 1.8 μg/week; haemoglobin (Hb) increased from 9.9 ± .8 g/dL to 1± 1.2 g/dL at first control, obtained after 1.4 ± .4 months. These changes corresponded to an ESA-R of .37 ± .38 g/dL/month/1 μg/week of ESA and tertiles limits were .17 and .47. Poor responders were younger and had lower GFR and higher proteinuria than intermediate and good responders. During the first 6 months of ESA therapy, poor responders showed lower Hb levels and sustained longer periods of Hb level <11 g/dL. During follow-up (median 3. years), 99 patients reached ESRD. At multivariable Cox's analysis, poor responsiveness was associated with higher risk of ESRD (hazard ratio 2.49, 95% confidence interval 1.28–4.84). ESA-R predicts renal prognosis in CKD patients followed in nephrology practice, where ESRD is the predominant outcome and ESA is commonly used at low dose.


Topic: Health

Add your comment

Please Login or Signup to leave a comment

Related stories

Comparison of methodologies to define hemodialysis patients hyporesponsive to epoetin and impact on counts and characteristics
submitted by sodighepaar 1 year and 1 month ago - Topic: Health
Some hemodialysis patients require large doses of erythropoiesis-stimulating agents (ESAs) to manage anemia. These patients, termed "ESA hyporesponsive," have been characterized using various definitions. We applied three definitions of hyporesponsiveness to a large, national cohort of hemodialysis patients to assess the impact of definition on counts and on characteristics associated with hypo...

Pretransplantation Erythropoiesis-Stimulating Agent Hyporesponsiveness Is Associated with Increased Kidney Allograft Failure and Mortality
submitted by jadeth 5 months ago - Topic: Health
Poor response to erythropoiesis-stimulating agents (ESA) is associated with morbidity and mortality among dialysis patients. It is unclear whether the risk associated with poor ESA response during dialysis extends beyond kidney transplantation. We examined pretransplantation ESA response and its effect on allograft failure and mortality. MethodsThe cohort included all adult Medicare recipients ...



Renal anaemia and EPO hyporesponsiveness associated with vitamin D deficiency: the potential role of inflammation
submitted by glinn234 1 year and 1 month ago - Topic: Health
Resistance to erythropoiesis-stimulating agents (ESAs) has been observed in a considerable proportion of patients with chronic kidney disease (CKD) and it is reportedly associated with adverse outcomes, such as increased cardiovascular morbidity, faster progression to end-stage renal disease (ESRD) and all-cause mortality. The major causes of ESA resistance include chronic inflammation producin...

Should we reconsider iron administration based on prevailing ferritin and hepcidin concentrations?
submitted by harndag 1 year and 6 months ago - Topic: Health
The results of recent randomized, controlled trials in patients with chronic kidney disease and anemia have suggested that hyporesponsiveness to erythropoiesis stimulating agents (ESA) is a significant predictor of poor patient outcomes. Functional iron deficiency (FID) is the most common cause of suboptimal ESA response, and intravenous iron administration (IVFe) efficiently raises hemoglobin ...


The Relationship between Red Cell Distribution Width with Erythropoietin Resistance in Iron Replete Hemodialysis Patients
submitted by wosin 1 year and 4 months ago - Topic: Health
Recently, erythropoietin resistance (ER) has been shown to be related with cardiovascular and overall mortality in hemodialysis (HD) patients. Red blood cell distribution width (RDW) has also shown to be associated with cardiovascular and all cause mortality in general population. Thus in the current study we tested the hypothesis that RDW and erythropoietin resistance as determined by erythrop...

Lisinopril pharmacokinetics and erythropoietin requirement in hemodialysis patients
submitted by printpok 1 year and 11 months ago - Topic: Health
There is ongoing controversy whether angiotensin converting enzyme inhibitors (ACE-I) contribute to anemia by causing hyporesponsiveness to erythropoiesis stimulating agents (ESA). However, it is unknown whether or not plasma levels or area under the curve (AUC) of ACE-I are associated with responsiveness to ESA-therapy. We examined the association between lisinopril AUC, lisinopril plasma leve...


The impact of hyporesponsiveness to erythropoietin-stimulating agents on time-dependent mortality risk among CKD stage 5D patients: a single-center cohort study
submitted by ossg12 1 year and 9 months ago - Topic: Health
Hyporesponsiveness to a large dose of erythropoietin-stimulating agents (ESA) could increase mortality risk among chronic kidney disease patients. This study aimed to assess a safe dose of ESA and the impact of hyporesponsiveness to ESA on mortality risk among hemodialyzed patients. Patients on hemodialysis were enrolled in this cohort study. The first year was used to assess the longitudinal d...

Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients
submitted by dorodero 3 months ago - Topic: Health
Anemia is a common complication among hemodialysis (HD) patients. Although intravenous iron and erythropoiesis-stimulating agents revolutionized anemia treatment, about 10% of HD patients show suboptimal response to these agents. Systemic inflammation and increased serum hepcidin level may contribute to this hyporesponsiveness. Considering the anti-inflammatory properties of omega-3 fatty acids...


Anemia of Chronic Disease
submitted by welsani 8 months ago - Topic: Health
(ACD) or inflammation may be secondary to infections, autoimmune disorders, chronic renal failure, or malignancies. It is characterized by an immune activation with an increase in inflammatory cytokines and resultant increase in hepcidin levels. In addition, inappropriate erythropoietin levels or hyporesponsiveness to erythropoietin and reduced red blood cell survival contribute to the anemia. ...

Erythropoietin-Induced Erythroid Precursor Pool Depletion Causes Erythropoietin Hyporesponsiveness
submitted by lode 1 year and 1 month ago - Topic: Health
The purpose of this study is to demonstrate that the erythroid precursor depletion in bone marrow induced by recombinant human erythropoietin (rHuEPO) treatment may be another contributing factor to erythropoietin hyporesponsiveness. Healthy Wistar rats were given single dose (SD) or multiple doses (MD) of rHuEPO (100 IU/kg). In MD study, animals were challenged with thrice-weekly over two week...