ESA hyporesponsiveness is associated with adverse events in maintenance hemodialysis (MHD) patients, but not with iron storage

Takahiro Kuragano, Kenichiro Kitamura, Osamu Matsumura, Akihiko Matsuda, Taiga Hara, Hideyasu Kiyomoto, Toshiaki Murata, Shouichi Fujimoto, Hiroki Hase, Nobuhiko Joki, Atushi Fukatsu, Toru Inoue, Yukihiro Itakura, Takeshi Nakanishi

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Objective It has been reported that hyporesponsiveness to erythropoiesis-stimulating agent (ESA) is associated with adverse events in patients on maintenance hemodialysis (MHD). However, it has not been determined whether higher iron storage is associated with an improved response, including better survival, to ESA. Design and Method We measured serum ferritin, hemoglobin (Hb), and transferrin saturation (TSAT) levels every three months for two years in 1,095 MHD patients. The weekly dose of ESA to Hb ratio was also calculated as an index of ESA responsiveness (ERI). Results A significant correlation (p<0.001, R = 0.89) between ferritin and Hb was only observed in the patients with ferritin levels <50 ng/mL. High-dose (≥50 mg/week) intravenous iron administration, female sex, low serum albumin, and angiotensin-converting enzyme inhibitor/ angiotensin receptor blocker use were significant predictors of a high ERI value (>280); however, serum ferritin and TSAT levels did not predict a higher ERI. In the time-dependent Cox hazard model, the risk for a composite event in the patients with a high ERI (≥280) and a high ferritin level (≥100 ng/mL) was significantly greater (hazard ratio [HR], 2.09, P = 0.033) than that for patients with a high ERI and a low ferritin (<100 ng/mL) level. Conclusion Hb was dependent upon ferritin levels in patients with ferritin levels <50 ng/mL but not in patients with ferritin levels ≥50 ng/mL. Patients with hyporesponsiveness to ESA had a greater risk of composite events, but ERI was unrelated to iron storage.

Original languageEnglish
Article numbere0147328
JournalPloS one
Volume11
Issue number3
DOIs
Publication statusPublished - 2016 Mar

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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