title: Effect of protein-energy malnutrition on erythropoietin requirement in maintenance hemodialysis patients.
abstract: Possible interactions between inflammatory and nutritional markers and their impact on recombinant human erythropoietin (rHuEPO) hyporesponsiveness are not well understood. We investigated the role of nutritional status in rHuEPO requirement in maintenance hemodialysis (MHD) patients without evidence of inflammation. This cross-sectional study included 88 MHD patients. The associations between required rHuEPO dose and malnutrition-inflammation score (MIS) and several laboratory values known to be related to nutrition and/or inflammation were analyzed. Anthropometric measures including body mass index, triceps skinfold thickness, and midarm circumferences were also measured. Twenty-three patients with serum C-reactive protein levels >10 mg/L were excluded from the analysis. The remaining 65 patients (male/female, 41/24; age 49.1+/-11.4 years; dialysis duration 99.7+/-63.0 months) were studied. These patients had moderate malnutrition and the average MIS was 7.4 (range 3-17). The average weekly dose of administered rHuEPO was 69.1+/-63.1 U/kg. Malnutrition-inflammation score had a positive correlation with the serum concentration of tumor necrosis factor-alpha, whereas it had a negative correlation with anthropometric measures, total iron-binding capacity, prealbumin, phosphorus, creatinine, and triglyceride. According to Pearson's correlation analysis, significant relationships of increased MIS with increased required rHuEPO dose and rHuEPO responsiveness index (EPO divided by hematocrit) were observed (p=0.008, r=-0.326; p=0.017, r=-0.306, respectively). Recombinant human erythropoietin dose requirement is correlated with MIS and adverse nutritional status in MHD patients without evidence of inflammation. Further research should focus on reversing the undergoing microinflammation for a better outcome in dialysis patients.
authors.affiliation: Department of Nephrology, Baskent University Hospital, Ankara, Turkey. arzuakgul@gmail.com
authors.forename: Arzu
authors.initials: A
authors.lastname: Akgul
authors.forename: Ayse
authors.initials: A
authors.lastname: Bilgic
authors.forename: Siren
authors.initials: S
authors.lastname: Sezer
authors.forename: Fatma Nurhan
authors.initials: FN
authors.lastname: Ozdemir
authors.forename: Irem
authors.initials: I
authors.lastname: Olcay
authors.forename: Zubeyde
authors.initials: Z
authors.lastname: Arat
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000328:Adult; D000886:Anthropometry; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007249:Inflammation; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011502:Protein-Energy Malnutrition; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin