Skeletal muscle mass is associated with erythropoietin response in hemodialysis patients

Abstract

Background Hyporesponsiveness to erythropoietin stimulating agent (ESA) is associated with poor outcomes in patients with chronic kidney disease. Although ESA hyporesponsiveness and sarcopenia have a common pathophysiological background, clinical evidence linking them is scarce. The purpose of the study was to investigate the relationship between ESA responsiveness and skeletal muscle mass in hemodialysis patients. Methods This cross-sectional study analyzed 70 patients on maintenance hemodialysis who were treated with ESA. ESA responsiveness was evaluated by erythropoietin resistance index (ERI), calculated as a weekly dose of ESA divided by body weight and hemoglobin (IU/kg/week/dL), and a weekly dose of ESA/hemoglobin (IU/week/dL). A dose of ESA is equivalated to epoetin β. Correlations between ESA responsiveness and clinical parameters including skeletal muscle mass were analyzed. Results Among the 70 patients, ERI was positively correlated to age (p < 0.002) and negatively correlated to height (p < 0.001), body weight (p < 0.001), BMI (p < 0.001), skeletal muscle mass (p < 0.001), transferrin saturation (TSAT) (p = 0.049), and zinc (p = 0.006). In the multiple linear regression analysis, TSAT, zinc, and skeletal muscle mass were associated with ERI and weekly ESA dose/hemoglobin. Conclusions Skeletal muscle mass was the independent predictor for ESA responsiveness as well as TSAT and zinc. Sarcopenia is another target for the management of anemia in patients with hemodialysis.

Responsiveness to an erythropoiesis-stimulating agent is correlated with body composition in patients undergoing chronic hemodialysis

“…Studies have reported that low BMI is related to ESA resistance (13,14,(31)(32)(33). The relationship can be hypothesized that the mass of organs with a high metabolic rate (such as the liver and gut) relative to body weight is inversely related to BMI, meaning that uremic toxin generation is reduced in larger individuals (13,34).…”

“…There does appear to be a link between ESA response and body composition. Previous studies have shown that muscle mass and adipose tissue levels may be associated with ESA responsiveness (13,14). Additionally, research investigating the interactions between erythropoietin and non-hematopoietic tissues, such as bone, fat, or muscle tissue, suggested that these body compartments could play a role in erythropoietin production, mechanism of action, and erythroid development (15,16).…”

Creatinine generation rate can detect sarcopenia in patients with hemodialysis

“…The prevalence of sarcopenia increases as renal function declines in patients with chronic kidney disease (CKD) [12,13]; therefore, sarcopenia may already exist at the initiation of dialysis. Sarcopenia has been shown to be related to responsiveness to erythropoietin and bone fracture in patients on HD [14,15]. Furthermore, sarcopenia has a significant impact on the prognosis of patients on HD [16].…”

The impact of muscle mass loss and deteriorating physical function on prognosis in patients receiving hemodialysis

“…Furthermore, previous studies have shown that the PMI has good reliability, including intra-rater reliability and inter-rater reliability 7 , 10 . Thus, several studies have recently investigated the PMI in patients receiving HD 7 – 9 and clarified that the PMI correlated with their long-term survival after cardiac surgery 8 and the erythropoietin response 9 . Contrastingly, few studies have investigated annual PMI changes in patients receiving HD.…”

“…Muscle mass is generally assessed using body composition, dual-energy X-ray absorptiometry, mid-arm muscle circumference, and the sum of skinfold thickness 6 ; however, it remains difficult to assess a large number of patients over time in routine medical care. Recently, several studies have used an alternative method to assess muscle mass in patients receiving HD, using the psoas muscle index (PMI), which is calculated based on the transverse area of the psoas muscle at the level of the third lumbar spine, identified via abdominal computed tomography (CT) 7 – 9 . The PMI is highly reproducible and considered a useful tool because it reflects the skeletal muscle mass of the whole body 7 , 10 .…”