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

Locatelli, Francesco; Andrulli, Simeone; Memoli, Bruno; Maffei, Camilla; Vecchio, Lucia Del; Aterini, Stefano; Simone, Walter De; Mandalari, Antonella; Brunori, Giuliano; Amato, Marcello; Cianciaruso, Bruno; Zoccali, Carmine

doi:10.1093/ndt/gfk011

Cited by 148 publications

(141 citation statements)

References 15 publications

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“…Comorbidities are thought to increase inflammatory state and hence associated with poor response to Epo [50,51]. The current study did not demonstrate a link between presence of hypertension, diabetes mellitus, congestive heart failure and ERI.…”

Section: Individual Response Variations To Erythropoietin Stimulatingcontrasting

confidence: 73%

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Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.

Ebid¹,

Elsawy²,

Taha³

2017

IOSRJPBS

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Section: Individual Response Variations To Erythropoietin Stimulatingcontrasting

confidence: 73%

“…Previous studies have shown that inflammation is one factor that reduces the response to Epo [6,50,63,64]. In addition, nutritional status plays a fundamental role in the clinical course of HD patients…”

Section: Individual Response Variations To Erythropoietin Stimulatingmentioning

confidence: 99%

Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.

Ebid¹,

Elsawy²,

Taha³

2017

IOSRJPBS

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“…This finding seems to be true in clinical practice; in hemodialysis patients, a lower serum albumin level is associated with ESA hyporesponsiveness (19).…”

Section: Introductionmentioning

confidence: 77%

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD

Schneider

Drechsler

Krane

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Hemodialysis treatment induces markers of inflammation and oxidative stress, which could affect hemoglobin levels and the response to erythropoietin use. This study sought to determine whether high-flux dialysis would help improve markers of renal anemia, inflammation, and oxidative stress compared with low-flux dialysis.Design, settings, participants, & measurements In a prospective, controlled study, 221 patients undergoing maintenance hemodialysis and receiving darbepoetin-alfa treatment (mean age, 66 years; 55% male) from 19 centers were screened in a 20-week run-in period of low-flux hemodialysis with a synthetic dialysis membrane. Thereafter, 166 patients were enrolled and randomly assigned to receive a synthetic high-flux membrane or to continue on low-flux dialysis for 52 weeks. Data on myeloperoxidase, oxidized LDL, high-sensitivity C-reactive protein, and the Malnutrition Inflammation Score were collected at baseline and after 52 weeks; routine laboratory data, such as hemoglobin, ferritin, and albumin, and the use of darbepoetin-alfa, were also measured in the run-in period.Results After 52 weeks, the low-flux and the high-flux groups did not differ with respect to hemoglobin (mean 6 SD, 11.760.9 g/dl versus 11.761.1 g/dl; P=0.62) or use of darbepoetin-alfa (mean dosage 6 SD, 29.8624.8 mg/wk versus 26.0631.1 mg/wk; P=0.85). Markers of inflammation, oxidative stress, or nutritional status also did not differ between groups.Conclusion Over 1 year, high-flux dialysis had no superior effects on hemoglobin levels or markers of inflammation, oxidative stress, and nutritional status. These data do not support the hypothesis that enhanced convective toxin removal would improve patient outcome.

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“…Among these factors, iron stores are most thoroughly described (7)(8)(9)(10)(11). Other factors include inflammation (12,13), adequacy of dialysis (14,15), nutritional status (16), and hyperparathyroidism (17).…”

mentioning

confidence: 99%

Iron, Inflammation, Dialysis Adequacy, Nutritional Status, and Hyperparathyroidism Modify Erythropoietic Response

Gawęda

Goldsmith²,

Brier³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: The erythropoietic response in hemodialysis patients depends on several physiologic factors. Most epidemiologic studies include the effect of these factors by representing them as confounders. This study tested the hypothesis that iron stores, inflammation, dialysis adequacy, nutritional status, and hyperparathyroidism act as nonlinear effect modifiers of the erythropoietic response and quantified the magnitude of those effects over clinically relevant ranges.Design, setting, participants, & measurements: The following retrospective data from 209 hemodialysis patients receiving Epoetin alfa (Epo) were collected: monthly: predialysis hemoglobin (Hgb), transferrin saturation, serum albumin, dialysis adequacy (Kt/V); quarterly: predialysis serum ferritin and intact parathyroid hormone over a period of 13 to 69 months. The study analyzed the dynamic relationship between hemoglobin and Epo, considering nonlinear effect modification by ferritin, transferrin saturation, Kt/V, albumin, and parathyroid hormone individually.Results: Maximum Hgb response to Epo was achieved for serum ferritin between 350 and 500 ng/ml, transferrin saturation greater than 30%, Kt/V greater than 1.4, and albumin greater than 3.8 g/dl. Hgb sensitivity to Epo decreases by about 30% as parathyroid hormone increases from 0 through 1000 pg/ml.Conclusions: Serum ferritin, transferrin saturation, Kt/V, serum albumin, and intact parathyroid hormone are markers of nonlinear effect modification of the erythropoietic response in hemodialysis patients.

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

Abstract: 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.

Cited by 148 publications

References 15 publications

Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.

Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD

Iron, Inflammation, Dialysis Adequacy, Nutritional Status, and Hyperparathyroidism Modify Erythropoietic Response

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