Myelodysplastic syndrome: the other cause of anemia in end-stage renal disease patients undergoing dialysis

Abstract

In end-stage renal disease (ESRD) patients receiving dialysis, anemia is common and related to a higher mortality rate. Erythropoietin (EPO) resistance and iron refractory anemia require red blood cell transfusions. Myelodysplastic syndrome (MDS) is a disease with hematopoietic dysplasia. There are limited reports regarding ESRD patients with MDS. We aim to assess whether, for ESRD patients, undergoing dialysis is a predictive factor of MDS by analyzing data from the Taiwan National Health Insurance Research Database. We enrolled 74,712 patients with chronic renal failure (ESRD) who underwent dialysis and matched 74,712 control patients. In our study, we noticed that compared with the non-ESRD controls, in ESRD patients, undergoing dialysis (subdistribution hazard ratio [sHR] = 1.60, 1.16–2.19) and age (sHR = 1.03, 1.02–1.04) had positive predictive value for MDS occurrence. Moreover, more units of red blood cell transfusion (higher than 4 units per month) was also associated with a higher incidence of MDS. The MDS cumulative incidence increased with the duration of dialysis in ESRD patients. These effects may be related to exposure to certain cytokines, including interleukin-1, tumor necrosis factor-α, and tumor growth factor-β. In conclusion, we report the novel finding that ESRD patients undergoing dialysis have an increased risk of MDS.

Known case of ESRD due to IgA nephropathy with myelodysplastic syndrome having perinephric hematoma and disseminated multi-drug resistant Klebsiella pneumonia infection in urinary tract, gastrointestinal tract and testes following living donor kidney transplantation: The strength of multidisciplinary team management

“…The study on MDS done in Taiwan found that undergoing dialysis and age had positive predictive value for MDS occurrence. Moreover, more units of red blood cell transfusion (higher than 4 units per month) was also associated with a higher incidence of MDS; the MDS cumulative incidence increased with the dura- tion of dialysis in ESRD patients [3]. However, in this patient, the dialysis vintage was 2 years.…”

“…However, in this patient, the dialysis vintage was 2 years. In patients with ESRD, the chances of MDS was increased if they required one unit of blood transfusion per week i.e., refractory anemia with adequate erythropoietin therapy and iron replacement [3]. In this patient, he had only 2 units of blood transfusion over 2 years; rare case.…”

“…Myelodysplastic Syndrome (MDS) is an acquired clonal hematopoietic cell disorder, clinically characterized by ineffective hematopoiesis leading to various degrees of cytopenia, dysplastic morphology in the bone marrow, and a tendency to transform into acute myelogenous leukemia. The prevalence of MDS was increased in patients with ESRD if the duration of hemodialysis was longer and the requirement for blood transfusion was increased [3].…”

Parathyroidectomy Improves the Consumption of Erythropoiesis-Stimulating Agents in Hemodialysis Patients

“…Second, we lacked bone marrow and cytogenetic data to measure the degree of bone marrow fibrosis and examine myelodysplastic syndrome, a hematopoietic disease. The cumulative incidence of myelodysplastic syndrome increases with the duration of dialysis [ 33 ]. Lastly, data for some factors, such as prior medical treatment for SHPT, were not available for analysis.…”