Erythropoietin and iron for anemia in HIV-infected patients undergoing maintenance hemodialysis in China: a cross-sectional study

Abstract

Background Anemia is a common complication of chronic kidney disease (CKD) and HIV infection. The number of people living with HIV on hemodialysis (HD) is increasing. However, there is no data about anemia and related therapies in this kind of patients in China. We aim to assess the difference in hemoglobin (Hgb) and treatments like erythropoietin and iron between HIV-HD patients and HD patients in Chengdu, China. Methods This cross-sectional study was conducted with data collection from January 2020 to June 2020. Thirty-four HIV-infected HD patients and thirty-five non-HIV-infected HD patients were included. Age, gender, dialysis vintage, single-pool (sp) Kt/V, Hgb, the dose of erythropoietin, ferritin, use of iron preparations, and serum albumin were collected in all patients. Time since HIV diagnosis, counts of CD4 + T cells, HIV RNA, and antiretroviral therapy for HIV infection were collected in HIV-infected patients. T-test, Mann–Whitney U test, and chi-square statistics were applied in SPSS. Results The Hgb of HIV-HD and HD groups were 105.70 (95.93–112.08) g/L and 112.00 (93.00–126.00) g/L respectively (P = 0.064). There was a statistically significant higher erythropoietin dosage used in the HIV-HD population (222.55 ± 115.47 U/kg/week) compared to the HIV-negative HD group (161.86 ± 110.31 U/kg/week) (P = 0.029). 16/34 (47.06%) HIV-HD patients and 5/35 (14.29%) HD patients were treated with iron preparations (P = 0.003). The ferritin levels were 316.50 (117.38–589.75) ng/ml and 272.70 (205.00–434.00) ng/ml in HIV-HD and HD groups respectively. Conclusions A higher erythropoietin dosage and a higher probability of iron preparations may be required to maintain Hgb in HIV-HD patients compared with HD patients.

Mechanisms and Cardiorenal Complications of Chronic Anemia in People with HIV

“…CKD and chronic anemia in this population are associated with adverse outcomes, including increased morbidity and mortality, and are linked to cardiovascular disease (CVD) [ 111 ]. Anemia is a common complication in both CKD and HIV infection, associated with an elevated risk of cardiovascular events and all-cause mortality [ 112 ]. In CKD, anemia, linked to reduced erythropoietin production, contributes to cardiovascular risk by promoting markers of endothelial activation and left ventricular hypertrophy [ 113 ].…”

“…The study by Li et al (2022) utilized humanized mice as a robust animal model to investigate the impact of chronic HIV-1 infection on HPCs [45]. The investigators found that HIV-1 infection significantly depleted the population of CD34+CD38-early HPCs in the bone marrow of humanized mice.…”