Hyporesponsiveness to long-acting erythropoiesis-stimulating agent is related to the risk of cardiovascular disease and death in Japanese patients on chronic hemodialysis: observational cohort study

Renal Replacement Therapy

Tsuyoshi Iwasaki¹  Hirotaka Saito¹  Shuhei Watanabe¹  Momoko Fujiwara¹  Akira Oda¹  Hiroshi Kimura¹  Kenichi Tanaka²  Makoto Kanno²  Junichiro James Kazama²  Jun Asai³  Keiji Sato³  Hodaka Suzuki⁴  Yoshihiro Tani⁵ 

[1] Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, 960-1295, Fukushima, Fukushima, Japan;Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikarigaoka, 960-1295, Fukushima, Fukushima, Japan;Department of Chronic Kidney Disease Initiatives, Fukushima Medical University, Fukushima, Japan;Fujita General Hospital, Kunimi, Japan;Hohrai East Clinic, Fukushima, Japan;Tani Hospital, Motomiya, Japan;

关键词: Erythropoiesis-stimulating agents;    Cardiovascular event;    Dialysis;    Hyporesponsiveness;    Mortality;   

DOI  :  10.1186/s41100-021-00332-0

来源: Springer

【 摘 要 】

BackgroundResponsiveness to erythropoiesis-stimulating agents (ESAs) is thought to be related to prognosis in patients on hemodialysis. A multi-center, prospective cohort study was conducted to investigate the effects of hyporesponsiveness to long-acting ESAs on cardiovascular events and mortality in Japanese patients on chronic hemodialysis.MethodsA total of 127 chronic hemodialysis patients treated with long-acting ESAs were followed-up prospectively. Responsiveness to ESA was evaluated using an erythropoietin resistance index (ERI) calculated by dividing the weekly body-weight-adjusted ESA dose by the hemoglobin concentration. The primary endpoint of this survey was defined as a combination of cardiovascular events and all-cause deaths. The association between hyporesponsiveness to ESAs evaluated by the highest quartile of the ERI and the primary endpoint was investigated.ResultsDuring the follow-up period (median 4.6 years), 32 patients reached the primary end point. Kaplan-Meier curve analysis showed that patients with ESA hyporesponsiveness belonging to the highest quartile of the ERI reached the primary end point more frequently than those without (P = 0.031). Cox regression analysis showed that an ERI in the highest quartile was an independent predictor of the primary end point, even after adjustment using a propensity score (hazard ratio 2.76, 95% confidence interval 1.19–6.40).ConclusionsESA hyporesponsiveness in hemodialysis patients treated with long-acting ESAs is related to cardiovascular events and death.

【 授权许可】

CC BY