Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients.
BACKGROUND
Chronic kidney disease patients who are resistant to erythropoietin (EPO) treatment may suffer from malnutrition and/or inflammation.


METHODS
In a cross-sectional study of haemodialysis patients, we investigated the relationship between the natural logarithm of the weekly EPO dose normalized for post-dialysis body weight and outcome measures of nutrition and/or inflammation [BMI, albumin and C reactive protein (CRP)] by means of multiple linear regression analysis. On the basis of the decile distribution of weekly EPO doses, we also evaluated four groups of patients: untreated, hyper-responders, normo-responders and hypo-responders.


RESULTS
Six hundred and seventy-seven adult haemodialysis patients were recruited from five Italian centres. BMI and albumin were lower in the hypo-responders than in the other groups (21.3+/-3.8 vs 24.4+/-4.7 kg/m(2), P<0.001; and 3.8+/-0.6 vs 4.1+/-0.4 g/dl, P<0.001), whereas the median CRP level was higher (1.9 vs 0.8 mg/dl, P = 0.004). The median weekly EPO dose ranged from 30 IU/kg/week in the hyper-responsive group to 263 IU/kg/week in the hypo-responsive group. Transferrin saturation linearly decreased from the hyper- to hypo-responsive group (37+/-15 to 25+/-10%, P = 0.003), without any differences in transferrin levels. Ferritin levels were lower in the hypo-responsive than in the other patients (median 318 vs 445 ng/ml, P = 0.01). At multiple linear regression analysis, haemoglobin, BMI, albumin, CRP and serum iron levels were independently associated with the natural logarithm of the weekly EPO dose (R(2) = 0.22).


CONCLUSIONS
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.
Locatelli
Francesco
F
Department of Nephrology and Dialysis, Ospedale A. Manzoni, Via dell'Eremo 9, 23900 Lecco, Italy.
Andrulli
Simeone
S
Memoli
Bruno
B
Maffei
Camilla
C
Del Vecchio
Lucia
L
Aterini
Stefano
S
De Simone
Walter
W
Mandalari
Antonella
A
Brunori
Giuliano
G
Amato
Marcello
M
Cianciaruso
Bruno
B
Zoccali
Carmine
C
D000368:Aged; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007249:Inflammation; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis
D004921:Erythropoietin; D002097:C-Reactive Protein