Document Detail


Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients.
MedLine Citation:
PMID:  16384825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Chronic kidney disease patients who are resistant to erythropoietin (EPO) treatment may suffer from malnutrition and/or inflammation. METHODS: In a cross-sectional study of haemodialysis patients, we investigated the relationship between the natural logarithm of the weekly EPO dose normalized for post-dialysis body weight and outcome measures of nutrition and/or inflammation [BMI, albumin and C reactive protein (CRP)] by means of multiple linear regression analysis. On the basis of the decile distribution of weekly EPO doses, we also evaluated four groups of patients: untreated, hyper-responders, normo-responders and hypo-responders. RESULTS: Six hundred and seventy-seven adult haemodialysis patients were recruited from five Italian centres. BMI and albumin were lower in the hypo-responders than in the other groups (21.3+/-3.8 vs 24.4+/-4.7 kg/m(2), P<0.001; and 3.8+/-0.6 vs 4.1+/-0.4 g/dl, P<0.001), whereas the median CRP level was higher (1.9 vs 0.8 mg/dl, P = 0.004). The median weekly EPO dose ranged from 30 IU/kg/week in the hyper-responsive group to 263 IU/kg/week in the hypo-responsive group. Transferrin saturation linearly decreased from the hyper- to hypo-responsive group (37+/-15 to 25+/-10%, P = 0.003), without any differences in transferrin levels. Ferritin levels were lower in the hypo-responsive than in the other patients (median 318 vs 445 ng/ml, P = 0.01). At multiple linear regression analysis, haemoglobin, BMI, albumin, CRP and serum iron levels were independently associated with the natural logarithm of the weekly EPO dose (R(2) = 0.22). CONCLUSIONS: Our findings support a clear association between EPO responsiveness and nutritional and inflammation variables in haemodialysis patients; iron deficiency is still a major cause of hypo-responsiveness.
Authors:
Francesco Locatelli; Simeone Andrulli; Bruno Memoli; Camilla Maffei; Lucia Del Vecchio; Stefano Aterini; Walter De Simone; Antonella Mandalari; Giuliano Brunori; Marcello Amato; Bruno Cianciaruso; Carmine Zoccali
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2005-12-29
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  21     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-03-24     Completed Date:  2006-09-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  991-8     Citation Subset:  IM    
Affiliation:
Department of Nephrology and Dialysis, Ospedale A. Manzoni, Via dell'Eremo 9, 23900 Lecco, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Body Weight
C-Reactive Protein / metabolism
Cross-Sectional Studies
Erythropoietin / therapeutic use*
Female
Humans
Inflammation*
Kidney Failure, Chronic / therapy*
Male
Middle Aged
Nutritional Status*
Renal Dialysis*
Chemical
Reg. No./Substance:
11096-26-7/Erythropoietin; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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