Shigeru Tanaka1, Hiromasa Kitamura1, Kazuhiko Tsuruya2, Takanari Kitazono1, Toshiaki Nakano3. 1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 2. Department of Nephrology, Nara Medical University, Nara, Japan. 3. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. nakano.toshiaki.455@m.kyushu-u.ac.jp.
Abstract
BACKGROUND: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) has been highlighted as a potential risk factor for cardiovascular disease in patients with chronic kidney disease (CKD). METHODS: We assessed cross-sectionally the prevalence, associated factors, and treatment status of anemia and ESA hyporesponsiveness in 4460 non-dialysis-dependent CKD patients enrolled in a multicenter cohort in Japan. Anemia was defined as a hemoglobin (Hb) level of less than 11 g/dL or receiving ESA therapy. ESA hyporesponsiveness was defined by the erythropoietin-resistance index (ERI), which was the erythropoietin dose per week divided by body weight and Hb level (U/kg/week/g/dl). RESULTS: Of the 4460 patients, 1050 (23.5%) had anemia. ESAs were administered to 626 patients, reaching a percentage of 57.5% of patients with stage G5 CKD. However, the ESA treatment rate was only 49.0% in patients with a hemoglobin level of < 11 g/dL. The proportion of patients receiving iron supplementation was lower than that of patients receiving ESAs regardless of CKD stage or hemoglobin level, and a significant proportion of patients did not receive iron supplementation, even those with iron deficiency. The ERI increased with CKD stage progression, and the multiple regression analysis showed that age, female sex, body mass index, cholesterol, glomerular filtration rate, and intact parathyroid hormone level were independent contributors. CONCLUSIONS: Our findings demonstrate that many Japanese patients with non-dialysis-dependent CKD receiving ESAs fail to maintain adequate hemoglobin levels. These results suggest the need for interventions for ESA hyporesponsiveness factors in addition to iron supplementation.
BACKGROUND: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) has been highlighted as a potential risk factor for cardiovascular disease in patients with chronic kidney disease (CKD). METHODS: We assessed cross-sectionally the prevalence, associated factors, and treatment status of anemia and ESA hyporesponsiveness in 4460 non-dialysis-dependent CKD patients enrolled in a multicenter cohort in Japan. Anemia was defined as a hemoglobin (Hb) level of less than 11 g/dL or receiving ESA therapy. ESA hyporesponsiveness was defined by the erythropoietin-resistance index (ERI), which was the erythropoietin dose per week divided by body weight and Hb level (U/kg/week/g/dl). RESULTS: Of the 4460 patients, 1050 (23.5%) had anemia. ESAs were administered to 626 patients, reaching a percentage of 57.5% of patients with stage G5 CKD. However, the ESA treatment rate was only 49.0% in patients with a hemoglobin level of < 11 g/dL. The proportion of patients receiving iron supplementation was lower than that of patients receiving ESAs regardless of CKD stage or hemoglobin level, and a significant proportion of patients did not receive iron supplementation, even those with iron deficiency. The ERI increased with CKD stage progression, and the multiple regression analysis showed that age, female sex, body mass index, cholesterol, glomerular filtration rate, and intact parathyroid hormone level were independent contributors. CONCLUSIONS: Our findings demonstrate that many Japanese patients with non-dialysis-dependent CKD receiving ESAs fail to maintain adequate hemoglobin levels. These results suggest the need for interventions for ESA hyporesponsiveness factors in addition to iron supplementation.
Authors: Suetonia C Palmer; Sankar D Navaneethan; Jonathan C Craig; David W Johnson; Marcello Tonelli; Amit X Garg; Fabio Pellegrini; Pietro Ravani; Meg Jardine; Vlado Perkovic; Giusi Graziano; Richard McGee; Antonio Nicolucci; Gianni Tognoni; Giovanni F M Strippoli Journal: Ann Intern Med Date: 2010-06-24 Impact factor: 25.391
Authors: Janani Rangaswami; Vivek Bhalla; John E A Blair; Tara I Chang; Salvatore Costa; Krista L Lentine; Edgar V Lerma; Kenechukwu Mezue; Mark Molitch; Wilfried Mullens; Claudio Ronco; W H Wilson Tang; Peter A McCullough Journal: Circulation Date: 2019-04-16 Impact factor: 29.690
Authors: Scott D Solomon; Hajime Uno; Eldrin F Lewis; Kai-Uwe Eckardt; Julie Lin; Emmanuel A Burdmann; Dick de Zeeuw; Peter Ivanovich; Andrew S Levey; Patrick Parfrey; Giuseppe Remuzzi; Ajay K Singh; Robert Toto; Fannie Huang; Jerome Rossert; John J V McMurray; Marc A Pfeffer Journal: N Engl J Med Date: 2010-09-16 Impact factor: 91.245
Authors: Ioannis Koulouridis; Mansour Alfayez; Thomas A Trikalinos; Ethan M Balk; Bertrand L Jaber Journal: Am J Kidney Dis Date: 2012-08-22 Impact factor: 8.860
Authors: Mark J Sarnak; Andrew S Levey; Anton C Schoolwerth; Josef Coresh; Bruce Culleton; L Lee Hamm; Peter A McCullough; Bertram L Kasiske; Ellie Kelepouris; Michael J Klag; Patrick Parfrey; Marc Pfeffer; Leopoldo Raij; David J Spinosa; Peter W Wilson Journal: Circulation Date: 2003-10-28 Impact factor: 29.690