title: Impact of gender and dialysis adequacy on anaemia in peritoneal dialysis.
abstract: OBJECTIVE
  In the general population, haemoglobin (Hb) concentration is higher in men than in women. However, target Hb levels in dialysis patients are set constant regardless of the patient's sex. The aim of this study was to evaluate Hb concentration and the use of erythropoiesis-stimulating agents (ESA) in peritoneal dialysis (PD) patients taking gender and dialysis adequacy into account.
  
  
  METHODS
  The study comprised two parts. The first was a cross-sectional analysis of Hb and ESA in 2180 prevalent PD patients. The second included 88 incident PD patients, followed for 36 months. During this time, the major parameters recorded at 12-month intervals included: Hb concentration, weekly ESA, total, renal, and peritoneal Kt/V. Erythropoietin resistance index (ERI) was calculated as the ratio between ESA dose and achieved Hb.
  
  
  RESULTS
  In prevalent PD patients, Hb concentration was significantly lower in women, (11.2 ± 1.4 vs. 11.5 ± 1.6 g/dl; p < 0.001), despite higher doses of ESA (2691 ± 1821 vs. 2344 ± 1422; p = 0.001). Hb concentrations were related to dialysis adequacy in both cohorts. However, despite significantly higher Kt/V, women were characterized by a lower Hb level. In incident patients, this association was present throughout the observation period, while the ESA dose in women was significantly higher at every time point. In multiple regression analysis, gender was an independent determinant of ERI (b = 0.34; p < 0.05).
  
  
  CONCLUSIONS
  Despite higher dialysis adequacy, Hb concentration in women treated with PD is significantly lower, and the ability to correct it impaired, as compared to men.
authors.affiliation: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.|Department of Hygiene and Epidemiology, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Ryta
authors.affiliation: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Chmielewski
authors.affiliation: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Debska-Slizien
authors.affiliation: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Jagodzinski
authors.affiliation: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Sikorska-Wisniewska
authors.affiliation: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland. lichotek@gumed.edu.pl.|Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Poland. lichotek@gumed.edu.pl.
authors.forename: Monika
authors.identifier: http://orcid.org/0000-0002-0262-3493
authors.initials: M
authors.lastname: Lichodziejewska-Niemierko
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D000068817:Epoetin Alfa / Q000008:administration & dosage*; D005260:Female; D006397:Hematinics / Q000008:administration & dosage; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D000068817:Epoetin Alfa
keywords: Anaemia; Dialysis adequacy; Erythropoiesis-stimulating agents; Gender; Peritoneal dialysis