Erythropoiesis-stimulating agent resistance and mortality in hemodialysis and peritoneal dialysis patients.
BACKGROUND
Responsiveness to erythropoiesis-stimulating agents (ESAs) varies widely among dialysis patients. ESA resistance has been associated with mortality in hemodialysis (HD) patients, but in peritoneal dialysis (PD) patients data is limited. Therefore we assessed the relation between ESA resistance in both HD and PD patients.


METHODS
NECOSAD is a Dutch multi-center prospective cohort study of incident dialysis patients who started dialysis between January 1997 and January 2007. ESA resistance was defined as hemoglobin level < 11 g/dL with an above median ESA dose (i.e. 8,000 units/week in HD and 4,000 units/week in PD patients). Unadjusted and adjusted Cox regression analysis for all-cause 5-year mortality was performed for HD and PD patients separately.


RESULTS
1013 HD and 461 PD patients were included in the analysis. ESA resistant HD patients had an adjusted hazard ratio of 1.37 (95% CI 1.04-1.80) and ESA resistant PD patients had an adjusted hazard ratio of 2.41 (1.27-4.57) as compared to patients with a good response.


CONCLUSIONS
ESA resistance, as defined by categories of ESA and Hb, is associated with increased mortality in both HD and PD patients. The effect of ESA resistance, ESA dose and hemoglobin are closely related and the exact mechanism remains unclear. Our results strengthen the need to investigate and treat causes of ESA resistance not only in HD, but also in PD patients.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. m.m.suttorp@lumc.nl.
Marit M
MM
Suttorp
Tiny
T
Hoekstra
Joris I
JI
Rotmans
Ilka
I
Ott
Moshe
M
Mittelman
Raymond T
RT
Krediet
Friedo W
FW
Dekker
D000740:Anemia / Q000401:mortality* / Q000517:prevention & control*; D015331:Cohort Studies; D015897:Comorbidity; D004351:Drug Resistance; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000401:mortality*; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000517:prevention & control*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D006397:Hematinics