Nutritional and inflammatory status influence darbepoetin dose in pre-dialysis elderly patients

Abstract

Anaemia is a common finding in elderly patients particularly in those with chronic kidney disease. Effective correction of anaemia improves survival and quality of life. The association between anaemia and a poor nutritional status as well as the presence of inflammation has already been documented. The aim of our study was to assess the impact of the nutritional and inflammatory status on darbepoetin dose requirements of elderly patients followed in a "Chronic Kidney Disease" outpatient clinic. We included 71 elderly patients (age>or=65 years) in a "Chronic Kidney Disease" outpatient clinic. Creatinine Clearance (CrCl) was estimated according to the Cockroft-Gault equation. Nutritional status was evaluated by biochemical and anthropometric parameters. Tumour Necrosis Factor-alpha (TNF-alpha), Interleukin-6 (IL-6) and high sensitivity C-reactive protein (hs-CRP) were used as biomarkers of inflammation. Our patients (56% males) with a mean age of 76.2+/-6.6 years were followed for 33.1+/-43.6 months. Mean eCrCl was 13.5+/-7.2 ml/mn/1.73 m2. All patients were under supplemental iron therapy and 74.7% needed darbepoietin (0.762+/-0.6 (microg/kg/week) to correct anaemia. Among the several variables regressed on darbepoietin dose, in a multiple regression model, only Hb, IL-6 and TNF-alpha levels and SGA score predicted the need for higher doses of darbepoietin. (r=0.677; r2=0.459). In Conclusion, in our pre-dialysis elderly patients, markers of a poor nutritional status (SGA and albumin) and inflammation (IL-6 and TNF-alpha) independently predicted the use of higher doses of darbepoietin to correct anaemia.

Risk factors for high erythropoiesis stimulating agent resistance index in pre-dialysis chronic kidney disease patients, stages 4 and 5

“…Several factors, such as hyperparathyroidism, aluminium intoxication, blood loss, hemoglobinopathies and hemolysis, are associated with ESA resistance [11]. Moreover, inflammation and malnutrition have been also described as factors that can be associated with anemia and can influence the ESA dose in patients with CKD [12][13][14][15][16]. On the other hand, recent studies indicated that the resistance to ESA [17,18], evaluated by the ESA resistance index [19] is associated with a higher risk of death in renal patients [20].…”

Promoting functioning and well-being in older CKD patients: review of recent evidence

“…Neves et al [40] investigated the impact of nutritional and inflammatory status on darbepoeitin dose requirements of 71 patients aged C65 years followed for 12 months in a pre-dialysis CKD clinic. Patient age ranged from 65 to 96 years (mean 76.2 ± 6.6 years).…”

Nephrogenic systemic fibrosis: an emerging entity

“…Using tissue reconstitution experiments with single hematopoietic stem cells (HSC), Ogawa et al [16] showed that HSC significantly contribute to myofibroblast population in tissues. Erythropoietin (EPO), parathyroid hormone (PTH), iron overload state, and an oxidative stress-induced ''stimulated hematopoietic environment'' [17][18][19][20][21][22] may thus contribute to fibrosis through increased production of tissue myofibroblasts. It is likely that both resident fibroblasts and diverse types of bone-marrow-derived cells that are released in response to injury and cytokines such as EPO, including HSC, endothelial progenitor cells, mesenchymal precursors, and monocyte-derived cell fibrocytes contribute to fibrogenesis in NSF (see Fig.…”

“…It is a potent cytokine with stimulatory effects on vascular endothelium, smooth muscle cells, and platelets [41][42][43][44]. EPO is also a potent stimulant of endothelial and progenitor cell proliferation as well as wound healing responses that are reminiscent of histological changes seen in NSF [18,45,46], EPO [18,45,47], and PTH [19] are also strong stimuli for a systemic release of CD34 + progenitor cells, which are known to participate in wound healing [16, 19,48]. Chronic inflammation [49] associated with an EPO resistant and high-dosage EPO [43,50] might also contribute to the fibrogenesis seen in NSF.…”