title: Associations among epoetin therapy, inflammation, nutritional status, and mortality in patients on hemodialysis.
abstract: OBJECTIVE
  Inflammation contributes to hemopoiesis by lowering responses to epoetin (EPO) and to an increase in the mortality of patients on hemodialysis. However, nutritional status might alter associations among inflammation, EPO responsiveness, and the risk of mortality. We assessed the effect of inflammation on mortality according to nutritional status among EPO responses in a cohort of prevalent hemodialysis patients.
  
  
  METHODS
  The observational cohort study analyzed data from the Japanese Dialysis Registry (2005-2006; n = 36,956; mean follow-up 11.5 months). Patients were categorized into tertiles of the EPO responsiveness index (ERI; the weekly weight-adjusted EPO dose [IU/kg/week] divided by hemoglobin [g/dL]) and an EPO-free group. Body mass index (BMI) and C-reactive protein (CRP) levels were measured.
  
  
  RESULTS
  Bimodal peaks indicated associations between CRP and BMI in each group. Hazard ratio (HR) curves of CRP for mortality according to BMI in the upper ERI tertile, particularly among those with diabetes mellitus (DM), were reverse J-shaped. However, HR curves in the other groups were increased below a threshold BMI of 21 kg/m(2). These associations were confirmed in propensity score-matched populations.
  
  
  CONCLUSIONS
  Risk of CRP for death is apparently changed by BMI in hemodialysis patients with a lower EPO response, especially in those with DM.
authors.affiliation: Division of Nephrology, Department of Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan. Electronic address: hondah@med.showa-u.ac.j.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Honda
authors.affiliation: Division of Blood Purification, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kimata
authors.affiliation: Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakai
authors.affiliation: Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis / Q000401:mortality*; D051437:Renal Insufficiency / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin; D002097:C-Reactive Protein