Hyporesponsiveness to erythropoiesis-stimulating agents and renal survival in non-dialysis CKD patients

Minutolo, Roberto; Conte, Giuseppe; Cianciaruso, Bruno; Bellizzi, Vincenzo; Camocardi, Andrea; De Paola, Luigi; De Nicola, Luca
July 2012
Nephrology Dialysis Transplantation;Jul2012, Vol. 27 Issue 7, p2880
Academic Journal
Background Lower responsiveness to erythropoiesis-stimulating agents (ESA-R) predicts cardiovascular (CV) events. Whether ESA-R also affects the risk of end-stage renal disease (ESRD) is unknown. Methods We evaluated ESA-R in 194 consecutive chronic kidney disease (CKD) patients, regularly seen in outpatient nephrology clinics, who started erythropoiesis-stimulating agent (ESA) therapy between 2002–06. Exclusion criteria were causes of anaemia other than CKD or recent transfusion. ESA-R was calculated as (Hb1 − Hb0)/time/ESA dose (g/dL/month/10 μg/week of ESA). Patients were classified, from lower to higher tertile of ESA-R, as poor, intermediate and good responders. Time to ESRD was the primary outcome. Results Age was 64 ± 16 years, 48% were male, 34% had diabetes and 32% had CV disease, glomerular filtration rate (GFR) 24 ± 13 mL/min/1.73 m2 and proteinuria 0.6 g/dL (interquartile range 0.2–1.9). First ESA dose was 23.7 ± 10.8 μg/week; haemoglobin (Hb) increased from 9.9 ± 0.8 g/dL to 11.0 ± 1.2 g/dL at first control, obtained after 1.4 ± 0.4 months. These changes corresponded to an ESA-R of 0.37 ± 0.38 g/dL/month/10 μg/week of ESA and tertiles limits were 0.17 and 0.47. Poor responders were younger and had lower GFR and higher proteinuria than intermediate and good responders. During the first 6 months of ESA therapy, poor responders showed lower Hb levels and sustained longer periods of Hb level <11 g/dL. During follow-up (median 3.0 years), 99 patients reached ESRD. At multivariable Cox's analysis, poor responsiveness was associated with higher risk of ESRD (hazard ratio 2.49, 95% confidence interval 1.28–4.84). Conclusion ESA-R predicts renal prognosis in CKD patients followed in nephrology practice, where ESRD is the predominant outcome and ESA is commonly used at low dose.


Related Articles

  • Anaemia and the heart and kidneys. Tollitt, James; Green, Darren; Kalra, Philip A.; McIntyre, Hugh N. // British Journal of Cardiac Nursing;Jun2012, Vol. 7 Issue 6, p276 

    Chronic kidney disease (CKD) and cardiovascular disease are intimately linked and both associated with anaemia. Anaemia in turn is associated with poor cardiovascular outcomes. Treatment with erythropoesisstimulating agents (ESA) and iron therapy has long been a staple of care in CKD and is...

  • Assessment of Iron Status in Anemic Children with Chronic Kidney Disease. Alzahrani, Ali K.; Alzahrani, Abdrahman; Al Nashar, Nihad A.; Mohamed, Hala A. // Egyptian Journal of Hospital Medicine; 

    Background: Iron deficiency is the commonest cause of resistance to erythropoiesis stimulating agents (ESAs) in dialyzed children treated from anemia of chronic kidney disease (CKD). Aim of the work: This study was conducted in order to evaluate the significance of different biomarkers in...

  • An Extended Terminal Half-Life for Darbepoetin Alfa: Results from a Single-Dose Pharmacokinetic Study in Patients with Chronic Kidney Disease not Receiving Dialysis. Padhi, Desmond; Ni, Liyun; Cooke, Blaire; Marino, Rafael; Jang, Graham // Clinical Pharmacokinetics;2006, Vol. 45 Issue 5, p503 

    BACKGROUND AND OBJECTIVE: Anaemia is a major and persistent manifestation of chronic kidney disease (CKD) caused by the deficient production of erythropoietin in the kidneys, the prevalence of which is proportional to the deterioration in kidney function. Darbepoetin alfa, an...

  • Cystatin C, kidney function and cardiovascular disease. B�kenkamp, Arend; Herget-Rosenthal, Stefan; B�kenkamp, Regina // Pediatric Nephrology;Sep2006, Vol. 21 Issue 9, p1223 

    Cystatin C, an endogenous low-molecular-weight marker of glomerular filtration rate, has recently been shown to be associated with future cardiovascular disease in healthy elderly populations and patients with documented atherosclerosis in a dose-dependent manner that possibly reflects a very...

  • Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey. Hallan, Stein I.; Dahl, Ketil; Oien, Cecilia M.; Grootendorst, Diana C.; Aasberg, Arne; Holrnen, Jostein; Dekker, Friedo W. // BMJ: British Medical Journal (International Edition);11/18/2006, Vol. 333 Issue 7577, p1047 

    Objective: To find an effective screening strategy for detecting patients with chronic kidney disease and to describe the natural course of the disease. Design: Eight year follow-up of a cross sectional health survey (the HUNT II study). Setting: Nord-Tr�ndelag County, Norway Participants:...

  • Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors? Moody, W E; Chue, C D; Inston, N G; Edwards, N C; Steeds, R P; Ferro, C J; Townend, J N // Journal of Human Hypertension;Mar2012, Vol. 26 Issue 3, p141 

    Chronic kidney disease (CKD) is now a recognized global public health problem. It is highly prevalent and strongly associated with hypertension and cardiovascular disease (CVD); far more patients with a glomerular filtration rate below 60 ml min−1 per 1.73 m2 will die from cardiovascular...

  • Estimation of glomerular filtration rate: does haemoglobin discriminate between ageing and true CKD? Ferrari, Paolo; Xiao, Jianguo; Ukich, Alf; Irish, Ashley // Nephrology Dialysis Transplantation;Jun2009, Vol. 24 Issue 6, p1828 

    Aim. The aim of this study was to analyse the association between chronic kidney disease (CKD) defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/ 1.73 m2 and anaemia in older people. Background. Guidelines focus on early identification and management of CKD to prevent CKD...

  • Effects of Statins on Renal Function. Agarwal, Rajiv // Mayo Clinic Proceedings;Nov2007, Vol. 82 Issue 11, p1381 

    Patients with chronic kidney disease (CKD) are much more likely to die of cardiovascular disease than end-stage renal disease. Dysilpidemia is highly prevalent in patients with CKD and may contribute to the elevated cardiovascular risk as well as CKD progression. Statins are lipid-lowering drugs...

  • A Study of Atherosclerosis in Patients with Chronic Renal Failure with Special Reference to Carotid Artery Intima Media Thickness. Paul, Jayanta; Dasgupta, Somnath; Ghosh, Mrinal Kanti; Shaw, Kishore; Roy, Keshab Sinha; Niyogi, Syamal Mitra // Heart Views;Jul-Sep2012, Vol. 13 Issue 3, p91 

    Objectives: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic renal failure (CRF). This study attempts to identify the factors responsible for atherosclerosis in CRF patients using carotid artery intima media thickness (CAIMT) as a surrogate marker...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics