title: Body mass index and resistance to recombinant human erythropoietin therapy in maintenance hemodialysis patients.
abstract: The aim of this work was to contribute to a better understanding of the relationship between resistance to recombinant human erythropoietin (rhEPO) therapy and body mass index (BMI) in hemodialysis (HD) patients. We evaluated 191 HD patients and 25 healthy individuals. Complete blood count, reticulocyte count, and circulating levels of ferritin, transferrin, iron, soluble transferrin receptor (sTfR), transferrin saturation, hepcidin, C-reactive protein (CRP), interleukin 6 (IL-6), albumin, and adiponectin were measured in all patients and controls. Non-responder patients (n = 16), as compared with responder patients (n = 175), showed statistically significant lower BMI values, an enhanced inflammatory and higher adiponectin levels, associated with disturbances in iron metabolism. Analyzing the results according to BMI, we found that underweight patients required higher rhEPO doses than normal, overweight, and obese patients, and a higher percentage of non-responders patients were found within the underweight group of HD patients. Moreover, underweight patients presented lower levels of transferrin and higher levels of adiponectin compared to overweight and obese patients, and lower levels of iron compared with normal weight patients. Multiple regression analysis identified the sTfR, hemoglobin, BMI, and albumin as independent variables associated with rhEPO doses. In conclusion, our work showed that HD patients resistant to rhEPO therapy present a functional iron deficiency and a higher degree of inflammation, despite their lower BMI values and higher levels of adiponectin. Actually, BMI is poorly related with markers of systemic inflammation, such as IL-6 and CRP, while adiponectin works a fairly good indirect marker of adiposity within HD patients.
authors.affiliation: Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto , Porto , Portugal .
authors.forename: Maria
authors.initials: M
authors.lastname: do Sameiro-Faria
authors.forename: Sandra
authors.initials: S
authors.lastname: Ribeiro
authors.forename: Petronila
authors.initials: P
authors.lastname: Rocha-Pereira
authors.forename: João
authors.initials: J
authors.lastname: Fernandes
authors.forename: Flávio
authors.initials: F
authors.lastname: Reis
authors.forename: Elsa
authors.initials: E
authors.lastname: Bronze-da-Rocha
authors.forename: Vasco
authors.initials: V
authors.lastname: Miranda
authors.forename: Alexandre
authors.initials: A
authors.lastname: Quintanilha
authors.forename: Elísio
authors.initials: E
authors.lastname: Costa
authors.forename: Luís
authors.initials: L
authors.lastname: Belo
authors.forename: Alice
authors.initials: A
authors.lastname: Santos-Silva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000517:prevention & control*; D015992:Body Mass Index; D016022:Case-Control Studies; D004351:Drug Resistance; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007501:Iron / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron