NDT Advance Access originally published online on December 29, 2005
Nephrology Dialysis Transplantation 2006 21(4):991-998; doi:10.1093/ndt/gfk011
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients
1 Department of Nephrology and Dialysis, Ospedale A. Manzoni, Lecco, 2 Department of Nephrology, Università di Napoli Federico II, Naples, 3 Department of Nephrology and Dialysis, ‘Spedali Civili’, Brescia, 4 Department of Nephrology and Dialysis, Ospedale ‘Misericordia e Dolce’, Prato, 5 Department of Nephrology, Azienda Ospedaliera ‘G.Moscati’, Avellino and 6 U.O. Nefrologia, CNR - I.B.I.M., Ospedali Riuniti Reggio Calabria, Italy
Correspondence and offprint requests to: Prof. Francesco Locatelli Department of Nephrology and Dialysis, Ospedale A. Manzoni, Via dell’Eremo 9, 23900 Lecco, Italy. Email: nefrologia{at}ospedale.lecco.it
Background. Chronic kidney disease patients who are resistant to erythropoietin (EPO) treatment may suffer from malnutrition and/or inflammation.
Methods. In a cross-sectional study of haemodialysis patients, we investigated the relationship between the natural logarithm of the weekly EPO dose normalized for post-dialysis body weight and outcome measures of nutrition and/or inflammation [BMI, albumin and C reactive protein (CRP)] by means of multiple linear regression analysis. On the basis of the decile distribution of weekly EPO doses, we also evaluated four groups of patients: untreated, hyper-responders, normo-responders and hypo-responders.
Results. Six hundred and seventy-seven adult haemodialysis patients were recruited from five Italian centres. BMI and albumin were lower in the hypo-responders than in the other groups (21.3±3.8 vs 24.4±4.7 kg/m2, P<0.001; and 3.8±0.6 vs 4.1±0.4 g/dl, P<0.001), whereas the median CRP level was higher (1.9 vs 0.8 mg/dl, P = 0.004). The median weekly EPO dose ranged from 30 IU/kg/week in the hyper-responsive group to 263 IU/kg/week in the hypo-responsive group. Transferrin saturation linearly decreased from the hyper- to hypo-responsive group (37±15 to 25±10%, P = 0.003), without any differences in transferrin levels. Ferritin levels were lower in the hypo-responsive than in the other patients (median 318 vs 445 ng/ml, P = 0.01). At multiple linear regression analysis, haemoglobin, BMI, albumin, CRP and serum iron levels were independently associated with the natural logarithm of the weekly EPO dose (R2 = 0.22).
Conclusions. Our findings support a clear association between EPO responsiveness and nutritional and inflammation variables in haemodialysis patients; iron deficiency is still a major cause of hypo-responsiveness.
Keywords: albumin; C reactive protein; EPO resistance; haemodialysis; inflammation; malnutrition
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