Association of malnutrition-inflammation complex and responsiveness to erythropoiesis-stimulating agents in long-term hemodialysis patients.

Abstract

BACKGROUND:

Protein-energy wasting, inflammation and refractory anemia are common in long-term hemodialysis patients. A decreased responsiveness to erythropoiesis-stimulating agents (ESA) is often the cause of the refractory anemia. We hypothesized that the malnutrition-inflammation complex is an independent predictor of decreased responsiveness to ESAs in hemodialysis patients.

METHODS:

This cohort study of 754 hemodialysis patients was examined for an association between inflammatory and nutritional markers, including the malnutrition-inflammation score (MIS) and responsiveness to ESA. Cubic spline models were fitted to verify found associations.

RESULTS:

The mean (±SD) age of patients was 54 ± 15 years, 53% were diabetic and 32% blacks. MIS was worse in the highest quartile of ESAs responsiveness index (ERI, ESA dose divided by hemoglobin) when compared with 1st quartile (6.5 ± 4.5 versus 4.4 ± 3.4; P < 0.001). Both C-reactive protein (log CRP) (β = 0.19) and interleukin-6 (log IL-6) (β = 0.32) were strong and independent predictors of ERI using multivariate linear regression. Serum albumin (β = -0.30) and prealbumin levels (β = -0.14) were inversely associated with ERI. Each 1 SD higher MIS, higher CRP and lower albumin were associated with 86, 44 and 97% higher likelihood of having highest versus three lowest ERI quartiles in fully adjusted models [odds ratio (and 95% confidence interval) of 1.86 (1.31-2.85), 1.44 (1.08-1.92) and 1.97 (1.41-2.78)], respectively. Cubic splines confirmed the continuous and incremental nature of these associations.

CONCLUSIONS:

Malnutrition-inflammation complex is an incremental predictor of poor responsiveness to ESAs in hemodialysis patients. Further studies are needed to assess whether modulating inflammatory or nutritional processes can improve anemia management.

• Authors: Manoch Rattanasompattikul, Miklos Z Molnar, Joshua J Zaritsky, Parta Hatamizadeh, Jennie Jing, Keith C Norris, Csaba P Kovesdy, Kamyar Kalantar-Zadeh
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 28 Issue 7 Pg. 1936-45 (Jul 2013) ISSN: 1460-2385 [Electronic] England
• PMID: 23045431 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Hematinics

Topics

• Anemia (drug therapy, etiology)
• Biomarkers (blood)
• Erythropoiesis (drug effects)
• Female
• Follow-Up Studies
• Glomerular Filtration Rate
• Hematinics (therapeutic use)
• Humans
• Inflammation (blood, diagnosis, etiology)
• Kidney Failure, Chronic (complications, therapy)
• Kidney Function Tests
• Male
• Malnutrition (blood, diagnosis, etiology)
• Middle Aged
• Prognosis
• Prospective Studies
• Renal Dialysis (adverse effects)
• Risk Factors
• Time Factors