Effect of erythropoietin levels on mortality in old age: the Leiden 85-plus Study

Elzen, Wendy P. J. den; Willems, J. M.; Westendorp, R. G. J.; Craen, Anton J. M. de; Blauw, G. J.; Ferrucci, L.; Assendelft, W. J. J.; Gussekloo, Jacobijn

doi:10.1503/cmaj.100347

Cited by 18 publications

(12 citation statements)

References 14 publications

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“…In addition to established predictors for mortality, such as age, history of CVD, and albumin (33), we identified elevated EPO levels as an independent risk factor. Similar results were observed in elderly patients (34), kidney transplant recipients (35), and patients with congestive heart failure (36,37). We observed that the association of EPO with the risk for death was even stronger than that of CRP or GFR, whereas low hemoglobin levels were not associated with the outcome after controlling for the described variables.…”

Section: Discussionsupporting

confidence: 84%

Endogenous Erythropoietin and the Association with Inflammation and Mortality in Diabetic Chronic Kidney Disease

Wagner

Alam

Zimmermann

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Anemia and inflammation are prevalent in diabetic patients with chronic kidney disease (CKD). The role of endogenous erythropoietin (EPO) in the pathophysiology of anemia in chronic diseases and its relationship to clinical outcomes remain uncertain. In this cohort study, we aimed to identify factors associated with endogenous EPO levels and investigate their relation to all-cause mortality. Results Patients (median age, 67 years; 52% men; median duration of diabetes, 10 years; median estimated GFR, 49 ml/min per 1.73 m 2 ) were followed for up to 7.0 years. Forty-one patients died. Elevated EPO levels were independently associated with elevated C-reactive protein, low ferritin, and hypertension, in a multivariate model that also included age, cardiovascular disease, kidney function, albumin, cholesterol, and hemoglobin. Higher EPO levels were independently predictive for mortality, as were age, low levels of albumin, and cardiovascular disease. ConclusionsIn diabetic patients with CKD, elevated endogenous EPO levels were predictive for mortality and were related mainly to markers of inflammation, independent of kidney function, and despite low hemoglobin levels. Understanding the phenomenon of EPO resistance and iron dysregulation caused by inflammation is crucial for effective and safe treatment of anemia in patients with CKD.

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Section: Discussionsupporting

confidence: 84%

Endogenous Erythropoietin and the Association with Inflammation and Mortality in Diabetic Chronic Kidney Disease

Wagner

Alam

Zimmermann

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Furthermore, this may not be a source of bias in our cohort because blood was taken in the morning hours uniformly. Smoking may modulate serum EPO (22). Interestingly, smoking was associated with lower serum EPO in our cohort.…”

Section: Discussionmentioning

confidence: 50%

“…In recent observational studies elevated endogenous EPO levels were predictive for mortality both in diabetic patients with CKD (21) and among people aged 85 years and older (22). Moreover, serum EPO was inversely associated with hemoglobin in kidney transplant recipients (23).…”

Section: Introductionmentioning

confidence: 96%

Serum Erythropoietin Level and Mortality in Kidney Transplant Recipients

Molnar

Tabák

Alam

et al. 2011

Clinical Journal of the American Society of Nephrology

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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.

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“…1 Nevertheless, few studies have prospectively evaluated predictors of mortality exclusively in older adults, 2,3 and even less information exists on the group of oldest old. [4][5][6] This subject has been addressed in a comprehensive manner with long-term follow-up registries such as the Leiden 85-plus study, 6 which found blood pressure 7 or erythropoietin 8 levels to predict long-term mortality in the cohort. Recently, Taekema et al 6 reported that gait speed in the oldest old is a useful tool to assess survival prognosis in this population.…”

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confidence: 99%

Utility of Geriatric Assessment to Predict Mortality in the Oldest Old: The Octabaix Study 3-Year Follow-Up

Formiga

Ferrer

Chivite

et al. 2013

Rejuvenation Research

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Objective: Few studies have prospectively evaluated the utility of geriatric assessment tools as predictors of mortality in the oldest population. We investigated predictors of death in an oldest-old cohort after 3 years of follow-up. Methods: The Octabaix study is a prospective, community-based study with a follow-up period of 3 years involving 328 subjects aged 85 at baseline. Data were collected on functional and cognitive status, co-morbidity, nutritional and falls risk, quality of life, social risk, and long-term drug prescription. Vital status for the total cohort was evaluated after 3 years of follow-up. Results: Mortality after 3 years was 17.3%. Patients who did not survive had significantly poorer baseline functional status for basic and instrumental activities of daily living (Barthel and Lawton Index), higher comorbidity (Charlson), higher nutritional risk (Mini Nutritional Assessment), higher risk of falls (Tinetti Gait Scale), poor quality of life (visual analog scale of the Quality of Life Test), and higher number of chronic drugs prescribed. Cox regression analysis identified the Lawton Index (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73-0.89) and the number of chronic drugs prescribed (HR 1.09, 95% CI 1.01-1.18) as independent predictors of mortality at 3 years. Conclusions: Among the variables studied, the ability to perform instrumental activities of daily living and using few drugs on a chronic basis at baseline are the best predictors of which oldest-old community-dwelling subjects survive after a 3-year follow-up period.

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Effect of erythropoietin levels on mortality in old age: the Leiden 85-plus Study

Cited by 18 publications

References 14 publications

Endogenous Erythropoietin and the Association with Inflammation and Mortality in Diabetic Chronic Kidney Disease

Endogenous Erythropoietin and the Association with Inflammation and Mortality in Diabetic Chronic Kidney Disease

Serum Erythropoietin Level and Mortality in Kidney Transplant Recipients

Utility of Geriatric Assessment to Predict Mortality in the Oldest Old: The Octabaix Study 3-Year Follow-Up

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