title: Dynamics of the erythropoiesis stimulating agent resistance index in incident hemodiafiltration and high-flux hemodialysis patients.
abstract: Hyporesponsiveness to erythropoiesis-stimulating agent therapy in dialysis patients is poorly understood. Some studies report an improvement in the erythropoiesis-stimulating agent resistance index (ERI) with hemodiafiltration (HDF) versus high-flux hemodialysis (HD). We explored ERI dynamics in 38,340 incident HDF and HD patients treated in 22 countries over a 7-year period. Groups were matched by propensity score at baseline (6 months after dialysis initiation). The follow-up period (mean of 1.31 years) was stratified into 1 month intervals with delta analyses performed for key ERI-related parameters. Dialysis modality, time interval, and polycystic kidney disease were included in a linear mixed model with the outcome ERI. Baseline ERI was nonsignificantly higher in HDF versus HD treatment. ERI decreased significantly faster in HDF-treated patients than in HD-treated patients, was decreased in both HD and HDF when patients were treated with intravenous darbepoetin alfa, but only in HDF when treated with intravenous recombinant human erythropoietin (rHuEPO). A clear difference between HD- and HDF-treated patients could only be found for patients with high baseline ERI and assigned to intravenous rHuEPO treatment. A significant advantage in terms of lower ERI for patients treated by HDF was found. Sensitivity analysis limited this advantage for HDF to those patients treated with intravenous rHuEPO (not darbepoetin alfa or subcutaneous rHuEPO) and to patients with a high baseline ERI. Thus, our results allow more accurate planning for future clinical trials addressing anemia management in dialysis patients.
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany. Electronic address: dmarcelli21@gmail.com.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Bayh
authors.affiliation: NephroCare, Madrid, Spain.
authors.forename: José I
authors.initials: JI
authors.lastname: Merello
authors.affiliation: NephroCare, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ponce
authors.affiliation: Fresenius Medical Care Renal Services, Birmingham, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Heaton
authors.affiliation: Fresenius Medical Care, Istanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Kircelli
authors.affiliation: NephroCare, Tassin, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Chazot
authors.affiliation: NephroCare, Naples, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Benedetto
authors.affiliation: Fresenius Medical Care, Buenos Aires, Argentina.
authors.forename: Cristina
authors.initials: C
authors.lastname: Marelli
authors.affiliation: NephroCare Nephrology Center, Miskolc, Hungary.
authors.forename: Erzsebet
authors.initials: E
authors.lastname: Ladanyi
authors.affiliation: NephroCare, Poznan, Poland.
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Kroczak
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Stefano
authors.initials: S
authors.lastname: Stuard
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Aileen
authors.initials: A
authors.lastname: Grassmann
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Scatizzi
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Brand
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000740:Anemia / Q000188:drug therapy*; D015331:Cohort Studies; D000068256:Darbepoetin alfa / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D004351:Drug Resistance; D004921:Erythropoietin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000494:pharmacology* / Q000627:therapeutic use; D017583:Hemodiafiltration; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D007690:Polycystic Kidney Diseases / Q000097:blood / Q000628:therapy; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006435:Renal Dialysis
chemical_list: C554270:EPO protein, human; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa
keywords: ERI; ESA; dialysis; hemodiafiltration; rHuEPO