Predictors of haemoglobin levels and resistance to erythropoiesis-stimulating agents in patients treated with low-flux haemodialysis, haemofiltration and haemodiafiltration: results of a multicentre randomized and controlled trial

Abstract

BackgroundPredictors of haemoglobin (Hb) levels and resistance to erythropoiesis-stimulating agents (ESAs) in dialysis patients have not yet been clearly defined. Some mainly uncontrolled studies suggest that online haemodiafiltration (HDF) may have a beneficial effect on Hb, whereas no data are available concerning online haemofiltration (HF). The objectives of this study were to evaluate the effects of convective treatments (CTs) on Hb levels and ESA resistance in comparison with low-flux haemodialysis (HD) and to evaluate the predictors of these outcomes.MethodsPrimary multivariate analysis was made of a pre-specified secondary outcome of a multicentre, open-label, randomized controlled study in which 146 chronic HD patients from 27 Italian centres were randomly assigned to HD (70 patients) or CTs: online pre-dilution HF (36 patients) or online pre-dilution HDF (40 patients).ResultsCTs did not affect Hb levels (P = 0.596) or ESA resistance (P = 0.984). Hb correlated with polycystic kidney disease (P = 0.001), C-reactive protein (P = 0.025), ferritin (P = 0.018), ESA dose (P < 0.001) and total cholesterol (P = 0.021). The participating centres were the main source of Hb variability (partial eta2 0.313, P < 0.001). ESA resistance directly correlated with serum ferritin (P = 0.030) and beta2 microglobulin (P = 0.065); participating centres were again a major source of variance (partial eta2 0.367, P < 0.001). Transferrin saturation did not predict either outcome variables (P = 0.277 and P = 0.170).ConclusionsIn comparison with low-flux HD, CTs did not significantly improve Hb levels or ESA resistance. The main sources of variability were participating centres, ESA dose and the underlying disease.

Improving Erythropoiesis Stimulating Agent Hyporesponsiveness in Hemodialysis Patients: The Role of Hepcidin and Hemodiafiltration Online

“…Since the availability of convective HD techniques, some pilot investigations have explored the ESA response comparing standard bicarbonate HD, hemofiltration (HF), and on-line hemodiafiltration (OL-HDF) [18]. …”

Biomarkers for Evaluation of Clinical Outcomes of Hemodiafiltration

“…More specifically, the benefits of HDF can be best utilized and good therapeutic efficacy achieved in the treatment of insomnia, pruritus, irritability, restless legs syndrome (RLS), anemia, dialysis amyloidosis (DA), etc., when removal performance of low-molecular-weight protein (LMWP) is improved [4,5,6,7]. …”

Effect of long period treatment with erythropoiesis stimulating agents on clinically and laboratory parameters in hemodialysis autosomal dominant polycystic kidney disease patients

“…The use of a percutaneous HD catheter was associated with a lower likelihood of being part of the non-ESA group. The presence of ADPKD correlated with higher levels of Hb than other underlying kidney diseases and a higher chance of patients belonging to the non-ESA group (2,10). In another study on 1318 HD patients (1307 in the ESA group and 11 in the non-ESA group), the non-ESA group had, again, a higher proportion of men, with a higher dialysis vintage, a higher prevalence of ADPKD, but also an increased level of endogenous EPO.…”