Erythropoietin Resistance Index and the Affecting Factors in Children with Peritoneal Dialysis

2021 ◽  
pp. 1-10
Author(s):  
Ayşe Seda Pınarbaşı ◽  
Ismail Dursun ◽  
Neslihan Günay ◽  
Batsaikhan Baatar ◽  
Sibel Yel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Resistance Index ◽  
Affecting Factors ◽  
Glucose Exposure ◽  
The Mean ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance ◽  
Very High ◽  
Average Hemoglobin

<b><i>Background:</i></b> Erythropoiesis-stimulating agents (ESAs) are used to treat anemia in CKD. Erythropoietin resistance index (ERI) is a useful tool used to evaluate the response to ESAs. In this study, we aimed to evaluate the causes of high ERI in children undergoing peritoneal dialysis (PD). <b><i>Method:</i></b> Patients who had been on PD for at least 1 year were included in this retrospective study. Demographic characteristics, residual kidney function (RKF), adequacy of dialysis, peritoneal glucose exposure, the number and reason for hospitalization, and medications were recorded. Anemia and laboratory parameters that may affect anemia were noted by taking the average of laboratory values in the last follow-up year (time-averaged). The weekly ESA dose was proportioned to the annual average hemoglobin value and body weight to calculate the ERI in terms of U/kg/week/g/dL. <b><i>Results:</i></b> A total of 100 patients were included in the study. The mean ESA dose and ERI value were 119.8 ± 66.22 U/kg/week and 13.01 ± 7.52 U/kg/week/g/dL, respectively. It was determined that the patients &#x3c;5 years of age have very high ERI value, and these patients need 2 times more ESA than those &#x3e;10 years of age. Absence of RKF, large number of hospitalization, and ACEI use were also found to affect the ERI value negatively. <b><i>Conclusion:</i></b> We demonstrate that the most important factor affecting ERI value is young age. We also reveal that absence of RKF, large number of hospitalization, and ACEI use are also important variables affecting the ERI value.

scholarly journals Resistance to Erythropoiesis-Stimulating Agents in Pre-Dialysis and Post-Dialysis Mortality in Japanese Incident Hemodialysis Patients

2019 ◽  
Vol 47 (Suppl. 2) ◽  
pp. 31-37 ◽  
Author(s):  
Toshihide Hayashi ◽  
Nobuhiko Joki ◽  
Yuri Tanaka ◽  
Masaki Iwasaki ◽  
Shun Kubo ◽  
...  
Keyword(s):  
Cox Regression ◽  
Independent Predictor ◽  
Resistance Index ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Cox Regression Analysis ◽  
Definitive Evidence ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance

Background/Aims: There is lack of definitive evidence about the association between erythropoiesis-stimulating agent (ESA) responsiveness in the pre-dialysis phase and mortality. Therefore, we conducted a hospital-based, retrospective, cohort study to assess the predictive value of ESA response for prognosis in incident hemodialysis patients. Methods: A total of 108 patients without preexisting cardiovascular disease who had been started on maintenance hemodialysis were studied. ESA responsiveness just before starting dialysis was estimated using an erythropoietin resistance index (ERI). The endpoint was defined as all-cause death. Results: During a mean follow-up period of 3.1 ± 1.6 years, 18 (17%) patients died. Overall, the multivariate Cox regression analysis revealed that the log-transformed ERI remained an independent predictor of all-cause death after adjustment using a propensity score (hazard ratio 2.25, 95% CI 1.25–4.06). Conclusions: Among incident hemodialysis patients, hyporesponsiveness to ESA may be associated with mortality.

scholarly journals P1373ERYTHROPOETIN RESISTANCE IN PRE-DIALYSIS PERIOD AND ITS RELATION TO PROGNOSIS IN JAPANESE INCIDENT DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Takatoshi MORINAGA ◽  
Atsushi FUKATSU ◽  
Takeshi ITO ◽  
Hirofumi TAMAI
Keyword(s):  
Logistic Regression ◽  
Cause Of Death ◽  
Resistance Index ◽  
Dialysis Patients ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance ◽  
Cvd Mortality

Abstract Background and Aims Erythropoiesis stimulating agents (ESA) are essential for better quality of life and longer life expectancy in end-stage kidney disease patients (ESKD). Resistance to ESA leads to worse prognosis in hemodialysis and peritoneal dialysis patients. Resistance to ESA exists in pre-dialysis period. We studied the clinical significance of pre-dialysis resistance to ESA by investigating the erythropoietin resistance index (ERI) in patients with ESKD prior to dialysis induction and its association with mortality and cause of death in three-year follow-up after dialysis initiation. Method Subjects included 1,420 patients in 17 centers participating in Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) from Oct. 2011 to Sep. 2013. ESA responsiveness was estimated by using erythropoietin resistance index (ERI) (U/kg/week/g/dL), which was calculated as weekly weight-adjusted epoetin dose divided by the hemoglobin (Hb) concentration before starting dialysis. We excluded 302 patients because ERI was not available. Thus, 1,118 subjects were enrolled. Subjects were divided into four categories of ERI; ERI &lt; 5, 5≤ ERI &lt;10, 10≤ ERI &lt;15 and 15≤ ERI. Cumulative survival rates from all-cause, cardiovascular disease (CVD), infection and malignancy were compared by Kaplan-Meier method according to ERI categories. Three-year mortality was analyzed by logistic regression analysis adjusted by age, gender, Charlson comorbidity index (CCI), and ERI categories. Results During three-year follow-up period, 191 (17.1%) patients died. Age and female gender share were higher in proportion to ERI. Diabetes, coronary artery disease (CAD), and values of albumin (Alb) and brain natriuretic peptide (BNP) were not correlated with ERI (Table 1). Kaplan-Meier survival curve showed that patients with the highest ERI (15≤ ERI) had a higher all-cause mortality (Log rank test p=0.002, Figure 1). Concerning the cause of death, mortality from infection (p=0.023, Figure 2) and malignancy (p=0.031) were high in the highest ERI category, however there was no significant difference in each ERI category regarding CVD mortality (p=0.33). According to multivariate analysis analyses by logistic regression model, all-cause (odd ratio [OD]: 1.65, 95% confidence interval [CI]: 1.14-2.38, p=0.008) and infection-related mortality (OR: 2.13, 95% CI: 1.08-4.11, p=0.029) were significantly correlated with the highest ERI category, but unexpectedly CVD mortality was not (OR: 1.04, 95% CI: 0.59-1.75, p=0.90). Mortality from malignancy did not reach the significant level (OR: 1.92, 95% CI: 0.96-3.73, p=0.063) and may require longer observation period for analysis. Conclusion Pre-dialysis ERI is a prognostic marker in Japanese dialysis patients and predicts the susceptibility to infection.

MO901ASSOCIATION OF MALNUTRITION AND INFLAMMATION WITH ERYTHROPOIETIN RESISTANCE INDEX

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Vitor Sá Martins ◽  
Teresa Adragao ◽  
Leila Aguiar ◽  
Catarina Dias ◽  
Rita Figueiredo ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Resistance Index ◽  
Nutritional Risk ◽  
Rank Test ◽  
Historical Cohort ◽  
Risk Of Mortality ◽  
Dialysis Vintage ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance

Abstract Background and Aims Erythropoietin Resistance Index (EPORI) has been previously associated with higher risk of mortality and morbidity in hemodialysis (HD) patients (pts). The objectives of this study were to identify which factors, such as the risk of malnutrition, are associated with EPORI and to assess its association with mortality and hospitalization risk. Method Historical cohort study in a group of high-flux HD pts from 25 outpatient HD clinics, starting from a baseline group of 2975 pts. We evaluated EPORI, interdialytic weigh gain (IDWG), Malnutrition Inflammation Score (MIS) and the other parameters at the study baseline. For a better understanding of weight gain patterns, we calculated the average of the IDWG at the day of monthly blood sample collection of the previous 3 months, values &gt;4% were considered high. A MIS&gt;5 indicated nutritional risk. Results We analyzed 2044 pts, 1148 (56%) males, 642 (31%) diabetic, with a mean age 68.4±14.12 years, a mean HD vintage 105±74 months and mean EPORI 7.23±7.51 (U/week/kg)/(g/dL). During a follow-up of 48 months, 719 pts (35%) died and 1291 pts (63%) were hospitalized at least once after baseline assessment, 531 pts and 400 pts were excluded because follow up was not possible and EPORI data was not available, respectively. ROC curve analysis identified different cut-off values for EPORI in relation with all-cause mortality and hospitalizations. Univariable analysis An EPORI&gt;5 was associated with higher MIS (7.06±3.9, vs 6.02±3.48, p&lt;0.001), higher IDWG (3.15±1.23 vs 1.26±1.09, p&lt;0.001), lower Hematocrit (Htc) (33.26±3.17 vs 33.69±2.61, p&lt;0.001), higher C-Reactive Protein (CRP) 14.94±24.45 vs 10.4±18.9, p&lt;0.001), female gender (57% vs 48%, p&lt;0.001), death (58% vs 49%, p&lt;0.001) and hospitalization (55% vs 47%, p&lt;0.001). When analyzing with Kaplan-Meier estimator using log-rank test to compare survival curves, mortality and hospitalizations were increased in all sub-groups with higher values for EPORI (cut-offs of 5 to 8) when compared, respectively, with lower EPORI values. Multivariable analysis The predictors of EPORI were MIS&gt;5 (OR 1.564, p&lt;0.001), IDWG (OR 1.234, p&lt; 0.001), CRP (OR 1.010, p&lt;0.001) and Htc (OR 0.948, p&lt;0.001). In similar models, adjusting for MIS&gt;5 (p&lt;0.001), gender (p&lt;0.001), age (p&lt;0.001), CRP (p&lt;0.001) and dialysis vintage (p&lt;0.001), different EPORI cut-off values were associated with higher risk of mortality and hospitalizations. Conclusion In the modern hemodialysis era, higher EPORI cut-off values were associated with a progressive higher risk of mortality and of hospitalization. The modification of the EPORI predictors that are susceptible to improvement, such as the nutritional and inflammation status, may contribute for a better prognosis in this population.

scholarly journals P1385BOLUS FERRIC CARBOXYMALTOSE ADMINISTRATION COULD BE A GOOD OPTION FOR IRON MAINTENANCE THERAPY IN HD FACILITIES WITHOUT REGULAR MEDICAL ASSISTANCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chiara Brunati ◽  
Denise Vergani ◽  
Francesca Gervasi ◽  
Alberto Montoli ◽  
Enrico Minetti
Keyword(s):  
Transferrin Saturation ◽  
Resistance Index ◽  
European Medicines Agency ◽  
Ferric Carboxymaltose ◽  
Iron Administration ◽  
Group A ◽  
Group B ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance

Abstract Background and Aims In 2013, the European Medicines Agency (EMA) claimed that iron preparations should be exclusively given in an environment where resuscitation facilities are available and, therefore, the iron administration was highly discouraged without the presence of a doctor. What this means is that in dialysis centres without regular medical presence the dose of iron administered might be inadequate. Ferric carboxyimaltose (FCM) allows to administer high single doses of iron with an excellent safety profile. Method We compare the effect of a maintenance iron therapy in two groups of prevalent and clinical stable hemodialysis patients; the former (A; n=19pts) was treated with iron gluconate (FG) in low refracted doses (i.e. 60 mg one or two times a week) while the latter (B;n=20 pts) was treated with FCM in high doses (i.e. 200 mg once or twice a month). The groups have been followed up for one year. All treated patients in the two groups had similar and “adequate” basal iron parameters according to European Clinical Guideline (Serum Ferritin(SF) ≥200 mic/l and transferrin saturation(TS) ≥20%) (see Table 1). The therapy was administered in order to maintain SF between 200-500 mic/l and TS between 20-40%. Erythropoietin dose (Epo) was evaluated considering the erythropoietin resistance index (ERI =EPO/weight/Hb). Results Table 1 show the results at the start and end follow up. The mean monthly iron dose was similar between the two groups at the end of follow up (144±100 mg group A vs 157±81 mg group B). In group A there was a more significant increase in the TS with a non-significant trend to an increase in SF. Six pts of group A had an overshooting of SF (1164±360mc/L) vs 3 pts in group B (SF 830±30 mc/L). No significant differences in pre and post therapy ERI could be recorded. Conclusion A therapy with a high single doses of FCM could be a positive solution to treat patients in dialysis centres without regular medical presence.

Relationships among the Dosage of Erythropoiesis-Stimulating Agents, Erythropoietin Resistance Index, and Mortality in Maintenance Hemodialysis Patients

2021 ◽  
pp. 1-11
Author(s):  
Sai Pan ◽  
De-Long Zhao ◽  
Ping Li ◽  
Xue-Feng Sun ◽  
Jian-Hui Zhou ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Resistance Index ◽  
Cox Proportional Hazards Model ◽  
Maintenance Hemodialysis ◽  
Erythropoiesis Stimulating Agents ◽  
All Cause Mortality ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance

<b><i>Background:</i></b> Erythropoiesis-stimulating agents (ESAs) constitute an important treatment option for anemia in hemodialysis (HD) patients. We investigated the relationships among the dosage of ESA, erythropoietin resistance index (ERI) scores, and mortality in Chinese MHD patients. <b><i>Methods:</i></b> This multicenter observational retrospective study included MHD patients from 16 blood purification centers (<i>n</i> = 824) who underwent HD in 2011–2015 and were followed up until December 31, 2016. We collected demographic variables, HD parameters, laboratory values, and ESA dosages. Patients were grouped into quartiles according to ESA dosage to study the effect of ESA dosage on all-cause mortality. The ERI was calculated as follows: ESA (IU/week)/weight (kg)/hemoglobin levels (g/dL). We also compared outcomes among the patients stratified into quartiles according to ERI scores. We used the Cox proportional hazards model to measure the relationships between the ESA dosage, ERI scores, and all-cause mortality. Using propensity score matching, we compared mortality between groups according to ERI scores, classified as either &#x3e; or ≤12.80. <b><i>Results:</i></b> In total, 824 patients were enrolled in the study; 200 (24.3%) all-cause deaths occurred within the observation period. Kaplan-Meier analyses showed that patients administered high dosages of ESAs had significantly worse survival than those administered low dosages of ESAs. A multivariate Cox regression identified that high dosages of ESAs could significantly predict mortality (ESA dosage &#x3e;10,000.0 IU/week, HR = 1.59, 95% confidence intervals (CIs) (1.04, 2.42), and <i>p</i> = 0.031). Our analysis also indicated a significant increase in the risk of mortality in patients with high ERI scores. Propensity score matching-analyses confirmed that ERI &#x3e; 12.80 could significantly predict mortality (HR = 1.56, 95% CI [1.11, 2.18], and <i>p</i> = 0.010). <b><i>Conclusions:</i></b> Our data suggested that ESA dosages &#x3e;10,000.0 IU/week in the first 3 months constitute an independent predictor of all-cause mortality among Chinese MHD patients. A higher degree of resistance to ESA was related to a higher risk of all-cause mortality.

scholarly journals Predictive value of resistive index in graft survival after kidney transplant

2014 ◽  
Vol 86 (4) ◽  
pp. 325 ◽  
Author(s):  
Saverio Forte ◽  
Pasquale Martino ◽  
Silvano Palazzo ◽  
Matteo Matera ◽  
Floriana Giangrande ◽  
...  
Keyword(s):  
Graft Survival ◽  
Predictive Value ◽  
Roc Analysis ◽  
Resistance Index ◽  
Resistive Index ◽  
A Value ◽  
Calculated Parameter ◽  
The Status ◽  
The Mean

Introduction: The intrarenal resistance index (RI) is a calculated parameter for the assessment of the status of the graft during the follow-up ultrasound of the transplanted kidney. Currently it is still unclear the predictive value of RI, also in function of the time. Materials and Methods: We retrospectively investigated the correlation between the RI and the graft survival (GS) and the overall survival (OS) after transplantation. We evaluated 268 patients transplanted between 2003 and 2011, the mean followup was 73 months (12-136). The RI was evaluated at 8 days, 6 months, 1 year and 3 years. The ROC analysis was used to calculate the predictive value of RI and the Kaplan Mayer curves was used to evaluated the OS and PS. Results: The ROC analysis, correlated to the GS, identified a value of RI equal to 0.75 as a cut-off. All patients was stratified according to the RI at 8 days (RI ≤ 0,75: 212 vs RI &gt; 0.75: 56), at 6 months (RI ≤ 0.75: 237 vs RI &gt; 0.75: 31), at 1 year (RI ≤ 0.75: 229 vs RI &gt; 0.75: 39) and at 3 years (RI ≤ 0.75: 224 vs RI &gt; 0.75: 44). The RI showed statistically significant differences between the two groups in favor of those who had an RI ≤ 0.75 only at 8 days and at 6 moths (p = 0.0078 and p = 0.02 to 8 days to 6 months) on the GS. On the contrary, we observed that the RI estimated at 1 year and 3 years has not correlated with the GS. The same RI cut-off was correlate with PS after transplantation. We observed that there are no correlations between the RI and OS. Conclusions: The RI proved to be a good prognostic factor on survival organ when it was evaluated in the first months of follow- up after transplantation. This parameter does not appear, however, correlate with OS of the transplanted subject.

Predictors of Residual Renal Function Decline in Peritoneal Dialysis Patients: ThebalANZ Trial

2017 ◽  
Vol 37 (3) ◽  
pp. 283-289 ◽  
Author(s):  
Htay Htay ◽  
Yeoungjee Cho ◽  
Elaine M. Pascoe ◽  
Darsy Darssan ◽  
Carmel Hawley ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Demographic Data ◽  
Urine Volume ◽  
Renin Angiotensin System ◽  
Residual Renal Function ◽  
Angiotensin System ◽  
Low Glucose ◽  
Glucose Exposure

ObjectivePreservation of residual renal function (RRF) is associated with improved survival. The aim of the present study was to identify independent predictors of RRF and urine volume (UV) in incident peritoneal dialysis (PD) patients.MethodsThe study included incident PD patients who were balANZ trial participants. The primary and secondary outcomes were RRF and UV, respectively. Both outcomes were analyzed using mixed effects linear regression with demographic data in the first model and PD-related parameters included in a second model.ResultsThe study included 161 patients (mean age 57.9 ± 14.1 years, 44% female, 33% diabetic, mean follow-up 19.5 ± 6.6 months). Residual renal function declined from 7.5 ± 2.9 mL/min/1.73 m2at baseline to 3.3 ± 2.8 mL/min/1.73 m2at 24 months. Better preservation of RRF was independently predicted by male gender, higher baseline RRF, higher time-varying systolic blood pressure (SBP), biocompatible (neutral pH, low glucose degradation product) PD solution, lower peritoneal ultrafiltration (UF) and lower dialysate glucose exposure. In particular, biocompatible solution resulted in 27% better RRF preservation. Each 1 L/day increase in UF was associated with 8% worse RRF preservation ( p = 0.007) and each 10 g/day increase in dialysate glucose exposure was associated with 4% worse RRF preservation ( p < 0.001). Residual renal function was not independently predicted by body mass index, diabetes mellitus, renin angiotensin system inhibitors, peritoneal solute transport rate, or PD modality. Similar results were observed for UV.ConclusionsCommon modifiable risk factors which were consistently associated with preserved RRF and residual UV were use of biocompatible PD solutions and achievement of higher SBP, lower peritoneal UF, and lower dialysate glucose exposure over time.

Erythropoietin Resistance Index and the All-Cause Mortality of Chronic Hemodialysis Patients

2014 ◽  
Vol 37 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Masayuki Okazaki ◽  
Mizuki Komatsu ◽  
Hiroshi Kawaguchi ◽  
Ken Tsuchiya ◽  
Kosaku Nitta
Keyword(s):  
Resistance Index ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
All Cause Mortality ◽  
Erythropoietin Resistance Index ◽  
Erythropoietin Resistance

Patient-Doctor Contact Interval and Clinical Outcomes in Continuous Ambulatory Peritoneal Dialysis Patients

2017 ◽  
Vol 45 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Chunyan Yi ◽  
Qunying Guo ◽  
Jianxiong Lin ◽  
Jianying Li ◽  
Xueqing Yu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Operating Characteristic ◽  
Patient Survival ◽  
Characteristic Curve ◽  
Survival Rates ◽  
Guangzhou City ◽  
Clinical Events ◽  
The Mean

Background: The optimal patient-doctor contact (PDC) interval remains unknown in peritoneal dialysis (PD) patients. The aim was to investigate the association between PDC interval and clinical outcomes in continuous ambulatory PD (CAPD) patients. Methods: In this retrospective cohort study, CAPD patients who resided in Guangzhou city between January 2006 and December 2012 were included. According to receiver operating characteristic curve analysis, all patients were classified as high (PDC interval ≤2 months) and low (PDC interval >2 months) PDC frequency groups. Biochemical data, clinical events, and clinical outcomes during the follow-up period were compared. Results: Of 433 CAPD patients, the mean age was 51.3 ± 15.7 years, 54.3% of patients were male, and 29.1% with diabetes. The median vintage of PD was 45.8 (26.3-69.1) months. Patients with high PDC frequency (n = 233) had better patient-survival rates (99.6, 87.7, and 76.5% vs. 92.7, 76.5, and 58.7% at 1, 3, and 5 years; p < 0.001), lower peritonitis rate (0.17 vs. 0.23 episodes per patient-year; p < 0.001), and hospitalization rate (0.49 vs. 0.67 episodes per patient-year; p < 0.001) than those in the low PDC frequency group (n = 200). After adjustment for confounders, PDC interval of no more than 2 months was independently associated with better patient survival (hazard ratio 0.60, 95% CI 0.42-0.86, p = 0.006). Conclusion: A PDC interval of 2 months or less was associated with better clinical outcomes in CAPD patients. This indicates that a shorter PDC interval should be encouraged for them to achieve better clinical outcomes.

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