Challenging the Validity of the EPO Index

Kaysen, George A.; Müller, H. G.; Ding, Jimin; Chertow, Glenn M.

doi:10.1053/j.ajkd.2005.09.013

Cited by 50 publications

(46 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data showed that in anuric patients ESA resistance was almost 40% higher than in patients with a GFR Ͼ 4.13 ml/min per 1.73 m 2 . Notably, a high ESA index has been associated with increased mortality in some (33,34) but not all studies (35). As expected and in agreement with previous observations, low TSAT and low albumin were significantly related to the ESA resistance, reflecting low available iron for erythropoiesis and inflammation, respectively (36 -38).…”

Section: Discussionsupporting

confidence: 78%

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Penne

Weerd

Grooteman

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients.Design, setting, participants, & measurements Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output Ն100 ml/24 h (n ϭ 295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output Ͻ100 ml/24 h, n ϭ 274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models.Results Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR Ͼ 4.13 ml/min per 1.73 m 2 ), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9 Ϯ 1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients. ConclusionsThis study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.

show abstract

Section: Discussionsupporting

confidence: 78%

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Penne

Weerd

Grooteman

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…73 A subsequent analysis of 32,566 Fresenius Inc. hemodialysis patients by the same authors did not confirm an association between IVI dose and risk of death after adjusting for time-varying measures of iron treatment and fixed and time-varying measures of morbidity, 74 whereas a study by Kaysen et al of 59,840 prevalent hemodialysis patients found that use of IVI was associated with a 22% reduction in mortality. 75 More recently, Kalantar-Zadeh et al studied 58,058 DaVita Inc. dialysis patients. For patients who received ,400 mg of IVI per month, the risk for death was found to be lower compared with patients with no IVI administered.…”

Section: Safety Signals In Epidemiology Studiesmentioning

confidence: 99%

Considerations and Challenges in Defining Optimal Iron Utilization in Hemodialysis

Charytan

Pai

Chan

et al. 2015

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Trials raising concerns about erythropoiesis-stimulating agents, revisions to their labeling, and changes to practice guidelines and dialysis payment systems have provided strong stimuli to decrease erythropoiesis-stimulating agent use and increase intravenous iron administration in recent years. These factors have been associated with a rise in iron utilization, particularly among hemodialysis patients, and an unprecedented increase in serum ferritin concentrations. The mean serum ferritin concentration among United States dialysis patients in 2013 exceeded 800 ng/ml, with 18% of patients exceeding 1200 ng/ml. Although these changes are broad based, the wisdom of these practices is uncertain. Herein, we examine influences on and trends in intravenous iron utilization and assess the clinical trial, epidemiologic, and experimental evidence relevant to its safety and efficacy in the setting of maintenance dialysis. These data suggest a potential for harm from increasing use of parenteral iron in dialysisdependent patients. In the absence of well powered, randomized clinical trials, available evidence will remain inadequate for making reliable conclusions about the effect of a ubiquitous therapy on mortality or other outcomes of importance to dialysis patients. Nephrology stakeholders have an urgent obligation to initiate well designed investigations of intravenous iron in order to ensure the safety of the dialysis population.

show abstract

“…Previous studies demonstrated an association between erythropoietin (EPO) resistance or reduced hematopoietic response to erythropoiesis-stimulating agents (ESAs) and poor clinical outcomes among chronic kidney disease (CKD) patients (11)(12)(13)(14)(15)(16)(17). It has been suggested that the dose of ESA may be a frequently neglected confounder for the association between higher targeted hemoglobin and mortality in randomized trials.…”

Section: Introductionmentioning

confidence: 99%

“…Based on the above, we hypothesize that similarly to resistance to exogenous ESA (16,17) resistance to endogenous EPO, represented by increased serum EPO levels, may represent a state of heightened risk in patients with CKD, in particular, those with posttransplant anemia. We investigated the association of serum EPO concentration and its ratio to hemoglobin (as a marker of endogenous EPO resistance) with mortality in a prospective cohort of prevalent kidney transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Serum Erythropoietin Level and Mortality in Kidney Transplant Recipients

Molnar

Tabák

Alam

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives Posttransplant anemia is frequently reported in kidney transplant recipients and is associated with worsened patient survival. Similar to high erythropoiesis-stimulating agent requirements, resistance to endogenous erythropoietin may be associated with worse clinical outcomes in patients with ESRD. We examined the association between serum erythropoietin levels and mortality among kidney transplant recipients.Design, setting, participants, & measurements We collected sociodemographic, clinical, medical, and transplant history and laboratory data at baseline in 886 prevalent kidney transplant recipients (mean age 51 Ϯ 13 [SD] years, 60% men, 21% diabetics). A solid-phase chemiluminescent immunometric assay was used to measure serum erythropoietin. Cox proportional hazards regression was used to model the association between baseline serum erythropoietin levels and all-cause mortality risk.Results During the median 39-month follow-up, 99 subjects died. The median serum erythropoietin level was 10.85 U/L and hemoglobin was 137 Ϯ 16 g/L. Mortality rates were significantly higher in patients with higher erythropoietin levels (crude mortality rates in the highest to lowest erythropoietin tertiles were 51.7, 35.5, and 24.0 per 1000 patient-years, respectively [P ϭ 0.008]). In unadjusted and also in adjusted Cox models each SD higher serum erythropoietin level significantly predicted all-cause mortality: HR 1SD increase 1.22 and 1.28, respectively. In adjusted Cox models each SD higher serum erythropoietin/blood hemoglobin ratio also significantly predicted all-cause mortality: HR 1SD increase 1.32. Serum erythropoietin predicted mortality in all analyzed subgroups. ConclusionsIn this sample of prevalent kidney transplant recipients, higher serum erythropoietin levels were associated with increased mortality.

show abstract

Challenging the Validity of the EPO Index

Cited by 50 publications

References 51 publications

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

Considerations and Challenges in Defining Optimal Iron Utilization in Hemodialysis

Serum Erythropoietin Level and Mortality in Kidney Transplant Recipients

Contact Info

Product

Resources

About