Responsiveness to Erythropoiesis‑Stimulating Agents and Hemoglobin Variability in Japanese Patients With End‑Stage Kidney Disease
Higher erythropoietin resistance index values are associated with greater hemoglobin variability in patients with end-stage kidney disease.
Where it sits
this study against the rest of the erythropoietin (epo) corpusSummary and findings
This study examined the association between the erythropoietin resistance index (ERI) and hemoglobin variability in 38 outpatients with end-stage kidney disease (ESKD) receiving maintenance hemodialysis. Higher ERI values were correlated with greater hemoglobin variability. No therapeutic claims are made.
Abstract
<title>Abstract</title> <p> <bold>Background</bold> Serum hemoglobin variability is a risk factor for cardiovascular mortality in end-stage kidney disease (ESKD). However, the indicators that reflect hemoglobin variability remain insufficiently investigated. We examined the association between the erythropoietin resistance index (ERI), a marker of responsiveness to erythropoiesis-stimulating agents, and hemoglobin variability in ESKD. <bold>Methods</bold> In this retrospective observational study, we enrolled 38 outpatients receiving maintenance hemodialysis, including two undergoing combined peritoneal-hemodialysis therapy. ERI at baseline and residual standard deviation of hemoglobin (Hb‑RSD) during follow‑up were evaluated. Independent determinants of ERI were identified using multiple regression analysis after adjusting for potential confounders. <bold>Results</bold> Relative to the low‑ERI group, the high‑ERI group (≥75th percentile) exhibited higher Hb-RSD. ERI was positively correlated with Hb‑RSD ( <italic>r</italic> = 0.473, <italic>p</italic> = 0.003). In multivariable regression analyses, ERI remained independently associated with Hb‑RSD after adjusting for confounding variables ( <italic>β</italic> = 0.607, <italic>p</italic> = 0.003). Furthermore, a receiver operating characteristic analysis for high Hb‑RSD (≥ 75th percentile) identified an ERI cutoff of 7.8 IU/kg·g/dL (AUC 0.729; sensitivity 70%; specificity 78%). <bold>Conclusions</bold> Among patients with ESKD, higher ERI values were associated with greater hemoglobin variability. ERI may serve as a useful surrogate marker for predicting hemoglobin fluctuations. Larger multicenter studies with longer follow-up are needed to confirm these findings. </p>
Background
Not reported in abstract.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Not reported in abstract.
Limitations
Not reported in abstract.