Relationship between erythropoietin resistance index and left ventricular mass and function and cardiovascular events in patients on chronic hemodialysis

Abstract

The response to erythropoietin (EPO) treatment varies considerably in individual patients on chronic hemodialysis. The EPO resistance index (ERI) has been considered useful to assess the EPO resistance and can be easily calculated in the clinic. The aim of this study was to investigate the association between ERI and left ventricular mass (LVM) and function and to determine whether ERI was associated with cardiovascular events in patients on hemodialysis. This study was designed prospectively. Clinical, laboratory, and echocardiographic variables were assessed in 72 patients on hemodialysis. The ERI was determined as the weekly weight-adjusted dose of EPO (U/kg/week) divided by hemoglobin concentration (g/dL). Patients were divided into three groups by tertiles of ERI. Patients with higher tertiles of ERI had a higher LVM index and lower LV ejection fraction compared with those with lower tertiles of ERI (P = 0.019 and P = 0.030, respectively). The median follow-up period was 53 months. The Kaplan-Meier plot showed increased frequency of cardiovascular events in patients with higher tertiles of ERI, compared with those with lower tertiles of ERI (P = 0.011, log-rank test). The multivariate Cox proportional hazard models showed that the ERI was the significant independent predictor of cardiovascular events (HR 3.00, 95% CI, 1.04-8.62, P = 0.042). Our data show that ERI was related with LVM index, LV systolic function and cardiovascular events in patients with hemodialysis. By monitoring of ERI, early identification of the EPO resistance may be helpful to predict the cardiovascular risk in hemodialysis patients.

A Randomized Control Study on the Procedure for Switching Epoetin Beta (EPO) to Epoetin Beta Pegol (CERA) in the Treatment of Renal Anemia in Maintenance Hemodialysis Patients

“…In addition, every-2-week administration in the early phase after switching further promoted the early stabilization of the blood CERA level, and more efficient hematopoiesis could be achieved through the inhibition of hepcidin compared to that achieved by directly switching to every-4-week administration, leading to a reduction of the CERA dose. High-dose ESA administration has been suggested to impair the prognosis of HD patients [20] and be associated with cardiovascular events [21]. Switching to every-2-week administration for a specific period may also be useful to reduce the ESA dose.…”

Erythropoietin Resistance Index and the All-Cause Mortality of Chronic Hemodialysis Patients

“…In order to use longitudinal dialysis status as a predictive value, laboratory data were measured during the second phase. The erythropoietin resistance index (ERI) was calculated by dividing the weekly body-weight-adjusted epoetin dose (international units per kilogram per week) by the hemoglobin concentration (grams per deciliter), as previously described [10]. The patients were divided into the following 3 groups by tertiles of ERI values: a lowest tertile (ERI = 2.0-5.0 IU/kg/week/g/dl); a middle tertile (ERI = 5.1-9.9 IU/kg/week/g/dl); and a highest tertile (ERI = 10.0-33.7 IU/kg/week/g/dl).…”

UK Renal Registry 16th Annual Report: Chapter 10 Haemoglobin, Ferritin and Erythropoietin amongst UK Adult Dialysis Patients in 2012: National and Centre-specific Analyses

“…Resistance to ESA has consistently been shown to be associated with an increased risk of death and cardiovascular events in CKD patients [14][15][16][17]. There is for the first time an attempt to describe the prevalence of ESA resistance in the UK and this was 0.5% and 0.6% for HD and PD patients respectively.…”