Obesity may be erythropoietin dose-saving in hemodialysis patients

Abstract

BackgroundIn dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt.MethodsThis multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated.ResultsObesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0–11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI.ConclusionOur study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.

Use of erythropoiesis-stimulating agents in obese hemodialysis patients

“…Interestingly, the present study [ 1 ] had relatively low ESA doses or ERIs in both non-obese and obese patients (median ESA dose of 6,000 vs. 4,000 U/week; median ERI of 8.0 vs. 4.3) compared to similar studies [ 3 , 4 ]. This seems to be related to the healthier characteristics of patients in this study (younger, less diabetic, and less hypertensive), although the authors showed no detailed information on the comorbidities.…”

“…I read with interest the article by El-Kannishy et al [ 1 ], in which fewer erythropoietin doses were required to achieve anemia control in obese hemodialysis (HD) patients in a multicenter observation study from Egypt. Given these results, I doubt if obesity, expressed as body mass index (BMI) > 30 kg/m 2 , by itself is an independent factor for determining dosage of erythropoietin-stimulating agents (ESAs).…”

“…El-Kannishy et al [ 1 ] compared ESA doses across BMI categories from underweight (< 18.5 kg/m 2 ) to third-degree obese groups (> 40 kg/m 2 ). A significant difference of ESA dose in different BMI subgroups was seen between underweight, normal weight, and overweight groups.…”

“…Finally, we are left with the question whether inflammation or nutritional status could be the major contributing factor for ESA dose-reduction in HD patients with a higher BMI. In addition, it is not clear which body composition—fat mass of muscle mass—is a dominant contributor to the association between ESA dose and BMI in this study [ 1 ]. If we admit that obesity independently induces ESA dose-saving in HD patients, the effects of adipokines on anemia parameters or ESA are worthy of exploration in future studies.…”

Erythropoiesis and Red Cell Indices Undergo Adjustments during Pregnancy in Response to Maternal Body Size but not Inflammation

“…Whether such a mechanism would result in pregnant women benefiting from obesity, in terms of erythropoiesis maintenance, is an hypothesis worth exploring. Such obesity-associated advantages have recently been reported in people who undergo hemodialysis [23].…”