title: Naturally nonanemic dialysis patients: Who are they?
abstract: Introduction Not only anemia, but also erythropoiesis stimulating agent (ESA)s for treating anemia may adversely affect prognosis of chronic hemodialysis patients. Various features of naturally (with no ESA usage) nonanemic patients may be useful for defining several factors in the pathogenesis of anemia. Methods Data, retrieved from the European Clinical Database (EuCliD)-Turkey on naturally nonanemic prevalent chronic hemodialysis patients (n: 201) were compared with their anemic (those who required ESA treatment) counterparts (n: 3948). Findings Mean hemoglobin values were 13.5 ± 0.8 and 11.5 ± 0.9 g/dL in nonanemic and anemic patients, respectively (P < 0.001). Nonanemia status was associated with younger age, male gender, longer dialysis vintage, nondiabetic status, more frequent hepatitis-C virus seropositivity and more frequent arteriovenous fistula usage. Serum ferritin and CRP levels and urea reduction ratio were higher in ESA-requiring patients. One (99%) and two (95.3%) years survival rates of the "naturally nonanemic" patients were superior as compared to anemics (91.0% and 82.6%, respectively), (P < 0.001). Discussion "Naturally nonanemic" status is associated with better survival in prevalent chronic hemodialysis patients; underlying mechanisms in this favorable outcome should be investigated by randomized controlled trials including large number of patients.
authors.affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Nephrology, Istanbul, Turkey. murvetyilmaz@hotmail.com.
authors.forename: Murvet
authors.initials: M
authors.lastname: Yilmaz
authors.affiliation: Fresenius Medical Care, Department of Nephrology, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Kircelli
authors.affiliation: Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey.
authors.forename: Ayse Serra
authors.initials: AS
authors.lastname: Artan
authors.affiliation: Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Oto
authors.affiliation: Ege Medical Faculty, Department of Nephrology, Izmir, Turkey.
authors.forename: Gulay
authors.initials: G
authors.lastname: Asci
authors.affiliation: Fresenius Medical Care, Department of Nephrology, Turkey.
authors.forename: Kutay
authors.initials: K
authors.lastname: Gunestepe
authors.affiliation: Ege Medical Faculty, Department of Nephrology, Izmir, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Basci
authors.affiliation: Ege Medical Faculty, Department of Nephrology, Izmir, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Ok
authors.affiliation: Istanbul Medical Faculty, Department of Nephrology, Istanbul, Turkey.
authors.forename: Mehmet Sukru
authors.initials: MS
authors.lastname: Sever
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D015996:Survival Rate
chemical_list: D006454:Hemoglobins
keywords: Hemodialysis; anemia; erythropoiesis stimulating agent; survival; treatment