Factors Predicting Erythropoeitin Resistance Among Maintenance Hemodialysis Patients
Hemodialysis.com Author Interview: Dr. Salman Mallick MD University Hospitals Case Medical Center, Case Western Reserve University |
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Hemodialysis.com: What are the main findings of the study? |
Results in our study are another step toward understanding erythropoietin resistance among maintenance hemodialysis patients. Higher levels of albumin, Kt/V and transferrin saturation, statin use and being male were associated with lower resistance to erythropoietin. Whereas patients on ACEi/ARB and with higher level of PTH showed increased resistance to erythropoietin. PTH association was weak but statistically significant. The study was limited by lack of data on inflammatory markers and type of vascular access to evaluate their impact in multivariate model. |
Hemodialysis.com: Were any of the findings unexpected? |
Impact of Statin and ACEi/ARB on erythropoietin resistance has been demonstrated previously in smaller studies with conflicting results. It was interesting to see Statin and ACEi/ARB use to remain statistically significant in a multivariate model. |
Hemodialysis.com: What should clinicians and patients take away from your report? |
ERI is considered as a marker of occult co morbidity and inflammatory status among HD patients. Since it is fairly easy to calculate, it can potentially become an added element in the patients’ periodic clinical reporting. An increase trend in ERI may prompt clinicians to look for potential reversible causes such as underling inflammatory processes, changes in the nutrition status; levels of functional iron or new medication use. |
Hemodialysis.com: What recommendations do you have for future research as a result of this study? |
Clarifying predictors of ERI would be clinically important that will not only have an economic impact but there is evidence albeit conflicting, of harmful effects associated with increasing dose of erythropoietin stimulating agent. Less well established factors need to be analyzed in more rigorous prospective studies that may include medication use among hemodialysis patients. |
Reference: Mallick S, Rafiroiu A, Kanthety R, Iqbal S, Malik R, Rahman M: |
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