Sai Pan1, De-Long Zhao2, Ping Li2, Xue-Feng Sun2, Jian-Hui Zhou2, Kang-Kang Song2, Yong Wang2, Li-Ning Miao3, Zhao-Hui Ni4, Hong-Li Lin5, Fu-You Liu6, Ying Li7, Ya Ni He8, Nian-Song Wang9, Cai-Li Wang10, Ai-Hua Zhang11, Meng-Hua Chen12, Xiao-Ping Yang13, Yue-Yi Deng14, Feng-Min Shao15, Shu-Xia Fu16, Jing-Ai Fang17, Guang-Yan Cai2, Xiang-Mei Chen2. 1. The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China, pansai301@126.com. 2. The PLA Medical College, Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China. 3. Department of Nephrology, The Second Hospital of Jilin University, Changchun, China. 4. Department of Nephrology, Renji Hospital, Shanghai Peritoneal Dialysis Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 5. Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China. 6. Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China. 7. Department of Nephrology, Third Hospital of Hebei Medical University, Kidney Disease Research Center of Hebei Province, Shijiazhuang, China. 8. Department of Nephrology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China. 9. Department of Nephrology, Affiliated The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China. 10. Department of Nephrology, First Affiliated Hospital of Baotou Medical College, Baotou, China. 11. Department of Nephrology, Peking University Third Hospital, Beijing, China. 12. Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China. 13. Department of Nephrology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, China. 14. Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China. 15. Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou, China. 16. Department of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, China. 17. Department of Nephrology, First Hospital of Shanxi Medical University, Taiyuan, China.
Abstract
BACKGROUND: 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. METHODS: This multicenter observational retrospective study included MHD patients from 16 blood purification centers (n = 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 > or ≤12.80. RESULTS: 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 >10,000.0 IU/week, HR = 1.59, 95% confidence intervals (CIs) (1.04, 2.42), and p = 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 > 12.80 could significantly predict mortality (HR = 1.56, 95% CI [1.11, 2.18], and p = 0.010). CONCLUSIONS: Our data suggested that ESA dosages >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.
BACKGROUND: 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. METHODS: This multicenter observational retrospective study included MHD patients from 16 blood purification centers (n = 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 > or ≤12.80. RESULTS: 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 >10,000.0 IU/week, HR = 1.59, 95% confidence intervals (CIs) (1.04, 2.42), and p = 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 > 12.80 could significantly predict mortality (HR = 1.56, 95% CI [1.11, 2.18], and p = 0.010). CONCLUSIONS: Our data suggested that ESA dosages >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.