Abstract | BACKGROUND: 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.
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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)
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Chemical References |
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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
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