Naturally nonanemic dialysis patients: Who are they?

Abstract

Introduction Not only anemia, but also erythropoiesis stimulating agent (ESA)s for treating anemia may adversely affect prognosis of chronic hemodialysis patients. Various features of naturally (with no ESA usage) nonanemic patients may be useful for defining several factors in the pathogenesis of anemia. Methods Data, retrieved from the European Clinical Database (EuCliD)-Turkey on naturally nonanemic prevalent chronic hemodialysis patients (n: 201) were compared with their anemic (those who required ESA treatment) counterparts (n: 3948). Findings Mean hemoglobin values were 13.5 ± 0.8 and 11.5 ± 0.9 g/dL in nonanemic and anemic patients, respectively (P < 0.001). Nonanemia status was associated with younger age, male gender, longer dialysis vintage, nondiabetic status, more frequent hepatitis-C virus seropositivity and more frequent arteriovenous fistula usage. Serum ferritin and CRP levels and urea reduction ratio were higher in ESA-requiring patients. One (99%) and two (95.3%) years survival rates of the "naturally nonanemic" patients were superior as compared to anemics (91.0% and 82.6%, respectively), (P < 0.001). Discussion "Naturally nonanemic" status is associated with better survival in prevalent chronic hemodialysis patients; underlying mechanisms in this favorable outcome should be investigated by randomized controlled trials including large number of patients.

Functional erythropoietin‐hepcidin axis in recombinant human erythropoietin independent haemodialysis patients

“…Thus, a combination of increased endogenous EPO and decreased hepcidin levels may be a hallmark to becoming rHU‐EPO free. No differences regarding iron homeostasis were suggested by the previous studies . The discrepancy observed between our study and previous reports might be because of (i) different target ferritin levels and (ii) modalities of iron supplementation depending on the country guidelines…”

“…No differences regarding iron homeostasis were suggested by the previous studies. [13][14][15][16][17] The discrepancy observed between our study and previous reports might be because of (i) different target ferritin levels and (ii) modalities of iron supplementation depending on the country guidelines. 22 Our findings raise new questions regarding the mechanisms that drive the restoration of a physiological hepcidin level in this population.…”

“…It allows to increase the patient haemoglobin (Hb) level which results in a reduction in blood‐transfusion rates and enhances their quality of life . Curiously, a small number of HD patients spontaneously recover normal Hb levels (> 12 g/dL) and no longer require ESAs or blood transfusions . The suggested mechanism for this recovery was a rescue of endogenous EPO production by kidneys and/or the liver.…”

“…11,12 Curiously, a small number of HD patients spontaneously recover normal Hb levels (> 12 g/dL) and no longer require ESAs or blood transfusions. [13][14][15][16][17] The suggested mechanism for this recovery was a rescue of endogenous EPO production by kidneys and/or the liver. Indeed, several studies have implicated the appearance of pathogenesis such as acquired renal or hepatic cysts, 18,19 adult polycystic kidney disease, 18 tumours, 20 and chronic viral hepatitis, 21 all of which were associated with increased production of EPO in these patient populations.…”

Briefly Noted

“…Among 3948 HD patients in 40 centers, 201 (5%) were naturally non‐anemic ( ). Compared to patients requiring ESAs, the non‐anemic patients were younger, and more often nondiabetic, male and more frequently hepatitis C positive.…”