Impact of gender and dialysis adequacy on anaemia in peritoneal dialysis

Abstract

PurposeIn 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.MethodsThe 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.ResultsIn 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).ConclusionsDespite higher dialysis adequacy, Hb concentration in women treated with PD is significantly lower, and the ability to correct it impaired, as compared to men.

Multifaceted Sexual Dysfunction in Dialyzing Men and Women: Pathophysiology, Diagnostics, and Therapeutics

“…Makruasi et al [ 48 ] conducted a comparable study on a larger patient group; they found that EPO hyporesponsiveness was 6.7% in their PD patient cohort, and that female gender was the predictive factor. In a large comparative study of PD patients, Ryta et al [ 49 ] found that women had significantly lower hemoglobin levels despite higher dialysis adequacy and higher doses of ESAs, and that gender was an independent determinant of ERI. Further large-scale cohort and comparative studies are required to explore the potential reasons for these findings.…”

Normalized Protein Catabolic Rate Is a Superior Nutritional Marker Associated With Dialysis Adequacy in Continuous Ambulatory Peritoneal Dialysis Patients

“…Indeed, these indices and body composition in general are different in males and females. Males also tend to produce more metabolites due to their larger body index, higher basal metabolism, and larger dietary intake, which combined with limited peritoneal clearance and residual renal function; these metabolites are not effectively cleared as they are in females, resulting in inadequate dialysis (17)(18)(19). However, the most recent ISPD guidelines set the target Kt/V level in dialysis patients as constant regardless of the patient's gender (8).…”

Erythropoietin Resistance Index and the Affecting Factors in Children with Peritoneal Dialysis

“…It is known that there is a relationship between ESA resistance and dialysis adequacy [28]. Ryta et al [28] found a relationship between ESA resistance and Kt/V in adult patients on PD, while a relationship between Kt/V and ERI was found in HD patients in the study by Okazaki et al [9] and no relationship between them in the study by Gunnell et al [29].…”