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NDT Advance Access published online on December 29, 2005
Nephrology Dialysis Transplantation, 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
Received July 10, 2005
Accepted November 24, 2005

Original Article

Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients

Francesco Locatelli 1 *, Simeone Andrulli 1, Bruno Memoli 2, Camilla Maffei 3, Lucia Del Vecchio 1, Stefano Aterini 4, Walter De Simone 5, Antonella Mandalari 6, Giuliano Brunori 3, Marcello Amato 4, Bruno Cianciaruso 2, and Carmine Zoccali 6

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
6 U.O. Nefrologia, CNR - I.B.I.M., Ospedali Riuniti Reggio Calabria, Italy

* To whom correspondence should be addressed.
Francesco Locatelli, E-mail: nefrologia{at}ospedale.lecco.it



  Abstract

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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