Risk factors for high erythropoiesis stimulating agent resistance index in pre-dialysis chronic kidney disease patients, stages 4 and 5.
OBJECTIVE
Anemia is common in patients with chronic kidney disease (CKD). Recently, the erythropoiesis-stimulating agent/hemoglobin level (ESA/Hb) index emerged as a new factor associated with increased morbidity and mortality in this population. In this study, we evaluated the factors that influence the ESA/Hb index in a pre-dialysis CKD population.


METHODS
Ninety-five patients were evaluated for clinical and laboratory parameters, nutritional status and ESA/Hb index. For comparison, we divided our population into 3 groups: G I--no ESA treatment, G II--patients with ESA/index below 50th percentile and G III--patients with ESA/Hb index above 50th percentile. We performed single and multiple regression models and logistic regression analysis.


RESULTS
In a multiple regression model, age (t = -3.456, P = 0.001), SGA (t = 2.059, P = 0.047), ferritin (t = 2.386, P = 0.027), Ca × P (t = 2.066, P = 0.043), TNF-α (t = 2.673, P = 0.009) and IL-6 (t = 2.939, P = 0.004) independently influenced the ESA/Hb index. At logistic regression analysis, gender, cardiovascular disease and TNF-α were independently associated with ESA/Hb higher than 50th percentile compared to the other patients (R(2) = 0.457).


CONCLUSIONS
In a pre-dialysis population, female gender, cardiovascular disease, malnutrition and inflammation are associated with a higher ESA/Hb index.
de Lurdes Agostinho Cabrita
Ana
A
Serviço de Nefrologia, Hospital de Faro, Rua Leão Penedo, 8000-342 Faro, Algarve, Portugal. anadelurdes@lycos.com
Pinho
Ana
A
Malho
Anabela
A
Morgado
Elsa
E
Faísca
Marília
M
Carrasqueira
Hermínio
H
Silva
Ana Paula
AP
Neves
Pedro Leão
PL
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002318:Cardiovascular Diseases / Q000150:complications; D016009:Chi-Square Distribution; D000068256:Darbepoetin alfa; D004351:Drug Resistance; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005293:Ferritins / Q000097:blood; D005919:Glomerular Filtration Rate; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000150:complications; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D006397:Hematinics; D006454:Hemoglobins; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D005293:Ferritins