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Clinical Trial
. 2013 Sep 25:14:200.
doi: 10.1186/1471-2369-14-200.

Erythropoiesis-stimulating agent resistance and mortality in hemodialysis and peritoneal dialysis patients

Marit M Suttorp  1 , Tiny Hoekstra, Joris I Rotmans, Ilka Ott, Moshe Mittelman, Raymond T Krediet, Friedo W Dekker
Affiliations
Clinical Trial

Erythropoiesis-stimulating agent resistance and mortality in hemodialysis and peritoneal dialysis patients

Marit M Suttorp et al. BMC Nephrol. .

Abstract

Background: Responsiveness to erythropoiesis-stimulating agents (ESAs) varies widely among dialysis patients. ESA resistance has been associated with mortality in hemodialysis (HD) patients, but in peritoneal dialysis (PD) patients data is limited. Therefore we assessed the relation between ESA resistance in both HD and PD patients.

Methods: NECOSAD is a Dutch multi-center prospective cohort study of incident dialysis patients who started dialysis between January 1997 and January 2007. ESA resistance was defined as hemoglobin level < 11 g/dL with an above median ESA dose (i.e. 8,000 units/week in HD and 4,000 units/week in PD patients). Unadjusted and adjusted Cox regression analysis for all-cause 5-year mortality was performed for HD and PD patients separately.

Results: 1013 HD and 461 PD patients were included in the analysis. ESA resistant HD patients had an adjusted hazard ratio of 1.37 (95% CI 1.04-1.80) and ESA resistant PD patients had an adjusted hazard ratio of 2.41 (1.27-4.57) as compared to patients with a good response.

Conclusions: ESA resistance, as defined by categories of ESA and Hb, is associated with increased mortality in both HD and PD patients. The effect of ESA resistance, ESA dose and hemoglobin are closely related and the exact mechanism remains unclear. Our results strengthen the need to investigate and treat causes of ESA resistance not only in HD, but also in PD patients.

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Figures

Figure 1
Figure 1
Hazard ratios for cardiovascular and non-cardiovascular mortality by ESA and Hb category. Values are shown as hazard ratios (95% Confidence intervals). Adjusted for age, sex, weight, primary kidney disease, diabetes mellitus, malignancy, cardiovascular disease, weekly Kt/V urea, rGFR, nutritional status, albumin, ferritin, PTH and CRP.
Figure 2
Figure 2
All-cause mortality for 8 categories of ESA and Hb in HD patients. Values are shown as hazard ratios (95% Confidence intervals). Adjusted for age, sex, weight, primary kidney disease, diabetes mellitus, malignancy, cardiovascular disease, weekly Kt/V urea, rGFR, nutritional status, albumin, ferritin PTH and CRP.
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References

    1. Locatelli F, Pisoni RL, Combe C, Bommer J, Andreucci VE, Piera L. et al.Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS) Nephrol Dial Transplant. 2004;19:121–132. doi: 10.1093/ndt/gfg458. - DOI - PubMed
    1. McFarlane PA, Pisoni RL, Eichleay MA, Wald R, Port FK, Mendelssohn D. International trends in erythropoietin use and hemoglobin levels in hemodialysis patients. Kidney Int. 2010;78:215–223. doi: 10.1038/ki.2010.108. - DOI - PubMed
    1. Eschbach JW, Egrie JC, Downing MR, Browne JK, Adamson JW. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. Results of a combined phase I and II clinical trial. N Engl J Med. 1987;316:73–78. doi: 10.1056/NEJM198701083160203. - DOI - PubMed
    1. Singh A. Hemoglobin control, ESA resistance, and regular low-dose IV iron therapy: a review of the evidence. Semin Dial. 2009;22:64–69. doi: 10.1111/j.1525-139X.2008.00518.x. - DOI - PubMed
    1. Johnson DW, Pollock CA, Macdougall IC. Erythropoiesis-stimulating agent hyporesponsiveness. Nephrology (Carlton) 2007;12:321–330. doi: 10.1111/j.1440-1797.2007.00810.x. - DOI - PubMed

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