Anaemia and resistance to erythropoiesis-stimulating agents as prognostic factors in haemodialysis patients: results from the RISCAVID study

Abstract

ESA responsiveness can be considered a strong prognostic factor in HD patients and seems to be tightly related to protein-energy wasting and inflammation.

Factors Contributing to Erythropoietin Hyporesponsiveness Among Hemodialysis Patients: A Cross-Sectional Multicenter Study

“…Low BMI had also been reported as the cause of erythropoietin resistance by Schneider et al among diabetic dialysis patients (12). Low serum albumin can affect EHRI among dialysis patients in RISCAVID study as well (3). Hypoalbuminemia could be the result of malnutrition or inflammation among our patients.…”

“…In order to evaluate the effect of inflammation on ESA response, we used CRP level as a marker of inflammation, which was not significantly different between the groups, as was the case in RISCAVID study (3).…”

“…ESA hyporesponsiveness is defined as failure to reach the recommended target hemoglobin despite high doses of ESA or requiring high doses to maintain the target hemoglobin. ESA hyporesponsiveness has a negative impact on dialysis patients' survival (3). On the other hand, increasing doses of ESAs are needed among patients with resistance that had been proven to be dangerous and associated with higher mortality rate (4).…”

The HIF System Response to ESA Therapy in CKD‐Anemia

“…According to the KDIGO guidelines [49], CKD patients can present initial or acquired ESA hyporesponsiveness; in primary hyporesponsiveness patients, after one month of treatment with adequate weight-based ESA dose, the target Hb concentration is not achieved; in acquired ESA hyporesponsiveness, after effective treatment with stable ESA dose, achieving the target Hb concentration, the patient requires two consecutive increases (up to 50% beyond the stable dose) in ESA dose. Hyporesponsiveness (also widely referred as resistance) to ESA therapy is associated with a poor outcome, progression of renal disease, sudden death, infectious complications, sudden death and all-cause mortality, mainly due to cardiovascular events in dialysis patients [76][77][78][79]. Several causes are associated with poor response to ESA therapy, including iron deficiency, inflammation, malnutrition and hyperparathyroidism, among others [80][81][82].…”

The Evolution of Biocompatibility: From Microinflammation to Microvesiscles

“…Various possible explanations may underline the advantage of IL-6 over CRP as a predictor of ESAs resistance. One possibility is that IL-6, being located upstream in the cascade of events which lead to the synthesis of many acute-phase reactants, is a better marker for the inflammatory burden affecting the development of CVD (Panichi et al, 2011). A frequently asked question is what is the contribution of HD bioincompatibility to the chronic inflammatory state.…”