Relationship between variations in time-dependent response to erythropoiesis-stimulating agents and mortality in hemodialysis patients: a single-center study

摘要

Background Hemodialysis (HD) patients who are resistant to erythropoiesis-stimulating agents (ESAs) have a higher mortality rate. The aim of this study was to assess the relationship between the time-dependent variability of ESA response in HD patients and mortality. Methods A total of 375 HD patients were enrolled in this study. The ESA resistance index (ERI) was calculated by dividing the weekly weight-adjusted ESA dose by hemoglobin concentration, and the average ERI was calculated from the ERI values every 2?months during a 36-month follow-up period. We divided the patients into six groups based on the patterns of their ERI level fluctuations: low-low (Low group), intermediate-intermediate (Intermediate group), high-high (High group), Low-intermediate group, Intermediate-high group, and Low-high group. Results There were 94 (25.1?%) deaths, and they included 51 (13.6?%) deaths from cardiovascular disease (CVD). A multivariate analysis with adjustment for age, serum albumin and C-reactive protein levels, and history of CVD showed that the High group was independently and significantly related to all-cause mortality (odds ratio?=?5.53, 95?% CI 2.29–13.99, p =?0.0001) and CVD-related mortality (odds ratio?=?3.49, 95?% CI 1.40–8.47, p =?0.0081). Conclusions High ERI levels are an independent risk factor for all-cause and CVD mortality in HD patients.