High Erythropoiesis Resistance Index Is a Significant Predictor of Cardiovascular and All-Cause Mortality in Chinese Maintenance Hemodialysis Patients

Autor: Qian Yu, Jialing Zhang, Xiangxue Lu, Shixiang Wang, Han Li
Rok vydání: 2020
Předmět:
Male
medicine.medical_treatment
030232 urology & nephrology
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Kidney
Severity of Illness Index
Gastroenterology
chemistry.chemical_compound
0302 clinical medicine
Pathology
RB1-214
Erythropoiesis
Prospective Studies
Prospective cohort study
biology
Mortality rate
Anemia
Middle Aged
Recombinant Proteins
C-Reactive Protein
Treatment Outcome
Creatinine
Regression Analysis
Female
Hemodialysis
Research Article
medicine.drug
Adult
China
medicine.medical_specialty
Article Subject
Immunology
03 medical and health sciences
Renal Dialysis
Albumins
Internal medicine
medicine
Humans
Erythropoietin
Aged
Inflammation
business.industry
Cell Biology
Alkaline Phosphatase
Ferritin
chemistry
Ferritins
biology.protein
Kidney Failure
Chronic
Complication
business
Zdroj: Mediators of Inflammation, Vol 2020 (2020)
Mediators of Inflammation
ISSN: 1466-1861
0962-9351
Popis: Background. Renal anemia is a common complication of hemodialysis patients. Erythropoietin (EPO) hyporesponsiveness has been recognized as an important factor to poor efficacy of recombinant human erythropoietin in the treatment of renal anemia. More importantly, increased erythropoiesis resistance index (ERI) may be associated with inflammation and increased mortality. Objective. The objective of this research was to investigate correlated factors of EPO responsiveness and to clarify the relationships between EPO hyporesponsiveness and cardiovascular mortality and all-cause mortality among maintenance hemodialysis patients. Methods. This prospective cohort study enrolled 276 maintenance hemodialysis patients for a 55-month follow-up to investigate the factors related to ERI and its relationship to all-cause mortality and cardiovascular mortality. Results. ERI was positively correlated with predialysis serum high-sensitivity C-reactive protein ( r = 0.234 , p < 0.001 ), alkaline phosphatase ( r = 0.134 , p = 0.028 ), and ferritin ( r = 0.155 , p = 0.010 ) and negatively correlated with albumin ( r = − 0.206 , p < 0.001 ) and creatinine ( r = − 0.232 , p < 0.001 ). As multiple linear regression showed, predialysis serum albumin, high-sensitivity C-reactive protein, ferritin, and creatinine were independent correlated factors of ERI ( p < 0.05 ). Kaplan–Meier curves showed that the cumulative incidences of both cardiovascular mortality and all-cause mortality were significantly higher in patients with ERI > 11.04 IU / kg / w / g / dL (both p < 0.01 ). The high ERI group was significantly associated with higher risk for all-cause mortality (OR 1.781, 95% CI 1.091 to 2.910, p = 0.021 ) and cardiovascular mortality (OR 1.972, 95% CI 1.139 to 3.417, p = 0.015 ) after adjusting for confounders. Conclusions. Predialysis serum albumin, high-sensitivity C-reactive protein, ferritin, and creatinine were independent correlated factors of EPO responsiveness among maintenance hemodialysis patients. Patients with higher ERI values had a higher all-cause mortality rate and cardiovascular mortality rate.
Databáze: OpenAIRE
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