The Predictive Parameters of Erythropoietin Hyporesponsiveness in Patients on Continuous Ambulatory Peritoneal Dialysis

Abstract

Background:The present study was aimed at investigating the predictive parameters of erythropoietin (epoetin) hyporesponsiveness in patients on continuous ambulatory peritoneal dialysis (CAPD).Methods:We studied 40 patients with end-stage renal disease who had been receiving CAPD for at least 6 months and epoetin therapy for at least more than 2 months. Pearson’s simple correlation and multiple stepwise linear regression analysis was used to discover what parameter can predict epoetin resistance. We expressed epoetin resistance index (ERI) as ‘weekly epoetin dose/hematocrit/body weight’. The dose of epoetin is titrated by about 25% every 2 to 4 weeks to maintain a target hematocrit level between 33% and 36%.Results:We analyzed the relationship between ERI and other predictive parameters by Pearson’s correlation. These results showed ERI has a statistically significant correlation with transferrin saturation (TS) (r=−0.327, p=0.042), total weekly Kt/Vurea (r=−0.423, p=0.018), serum albumin level (r=−0.458, p=0.003), normalized protein catabolic rate (nPCR) (r=−0.479, p=0.006), normalized protein equivalent of total nitrogen appearance (nPNA) (r=−0.488, p=0.005) and serum C-reactive protein (CRP) (r=0.332, p = 0.036). Regression analysis was performed using stepwise linear regression for multiple variables to discover the most independent variable which is correlated with ERI. ERI was entered as a dependent variable, whereas the other parameters (age, duration of peritoneal dialysis, serum albumin level, CRP, serum ferritin, total weekly Kt/Vurea, nPCR, nPNA, serum iPTH, serum aluminium, TS) were entered as independent variables. This analysis showed CRP is the most significant variable and, if CRP is excluded, nPNA is the significant variable. CRP has a statistically significant correlation with serum albumin level (r=−0.418, p=0.007) and total weekly Kt/Vurea (r=−0.366, p=0.043). High CRP group has more increased level of ERI (p<0.05), age (p<0.05) and serum creatinine level (p<0.05) than normal control, but more decreased level of serum albumin (p<0.01) and serum iron levels (p<0.05).Conclusion:These results indicate that CRP is the most important predictor of epoetin hyporesponsiveness.

Factors related to erythropoietin hypo-responsiveness in patients on chronic peritoneal dialysis

“…Similar results were reported from the European survey on anemia management [16]. Kim et al [8] reported that, in 40 continuous ambulant peritoneal dialysis (CAPD) patients, CRP was the most important predictor of EPO hypo-responsiveness. In our study, CRP levels in the group on an EPO dose !150 U/kg per week were significantly higher than those in the group on a dose <150 U/kg per week, and linear regression analysis showed a reverse relationship between ERI and CRP, which confirmed that CRP plays an important role in EPO resistance.…”

“…It was reported that serum albumin has a positive correlation with nPCR or the normalized protein equivalent of total nitrogen appearance (nPNA). Hypo-albuminemia, low nPCR (or nPNA) were indicators of both poor nutrition status and a predictive parameter of EPO hypo-responsiveness [2,8]. In our study we did not find any relationship between serum albumin and nPCR, but we did find that ERI had a negative correction with serum albumin and nPCR.…”

“…According to the literature, 90-95% of renal anemia responded in a dose-dependent manner to EPO, whereas the remaining 5-10% of patients had a blunted or no response to EPO, despite high-dose therapy [1][2][3]. Various factors that have been reported to be related to this hypo-responsiveness include inflammation status, nutritional status, and dialysis adequacy [4][5][6][7][8][9]. In this paper, we investigated factors that can predict EPO hypo-responsiveness and resistance in a group of patients on chronic peritoneal dialysis (PD).…”

Effect of silymarin administration on TNF‐α serum concentration in peritoneal dialysis patients

“…Nevertheless, it has been suggested that increased production of these cytokines may account for recombinant human erythropoietin (rhEpo) hypo-responsiveness. Therefore, reduction of infl ammatory cytokines can improve haematological status in advanced renal failure patients (Kim et al, 2001;Wei et al, 2007). In summary, these studies support the concept that silymarin antagonizes the action of pro-infl ammatory cytokines in treating infl ammatory anaemia in peritoneal dialysis patients.…”

Protocolized Anemia Management with Erythropoietin in Hemodialysis Patients

“…Several studies have evaluated the role of various laboratory measures in predicting rHuEpo responsiveness, including albumin (25,26), CRP (25)(26)(27), ferritin (25,28), TSAT (25,27,28), and several dialysis adequacy indices (26,28). These studies support the notion that markers of inflammation such as an elevated CRP or reduced serum albumin tend to be associated with higher rHuEpo requirements, whereas greater iron stores and increased dialysis dose are associated with reduced rHuEpo needs.…”