Cumulative iron dose and resistance to erythropoietin

Introduction Optimizing anemia treatment in hemodialysis (HD) patients remains a priority worldwide as it has significant health and financial implications. Our aim was to evaluate in a large cohort of chronic HD patients in Fresenius Medical Care centers in Spain the value of cumulative iron (Fe) d...

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Veröffentlicht in:Journal of nephrology Jg. 28; H. 5; S. 603 - 613
Hauptverfasser: Rosati, A., Tetta, C., Merello, J. I., Palomares, I., Perez-Garcia, R., Maduell, F., Canaud, B., Aljama Garcia, P.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Cham Springer International Publishing 01.10.2015
Springer Nature B.V
Schlagworte:
Aged
Anemia
Anemia - blood
Anemia - drug therapy
Anemia - etiology
Biomarkers - blood
C-reactive protein
Cardiovascular disease
Diabetes
Dose-Response Relationship, Drug
Drug Resistance
Erythropoietin - therapeutic use
Female
Follow-Up Studies
Hemodialysis
Hemoglobin
Hemoglobins - metabolism
Humans
Iron
Iron - administration & dosage
Kidney diseases
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - therapy
Male
Malnutrition
Medicine
Medicine & Public Health
Middle Aged
Mortality
Nephrology
Original Article
Patients
Renal Dialysis
Retrospective Studies
Urology
Variables
Spain
Serum Ferritin Level
Darbepoetin Alfa
Sevelamer
Ferritin
Iron Overload
ISSN:1121-8428, 1724-6059, 1724-6059
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Zusammenfassung:Introduction Optimizing anemia treatment in hemodialysis (HD) patients remains a priority worldwide as it has significant health and financial implications. Our aim was to evaluate in a large cohort of chronic HD patients in Fresenius Medical Care centers in Spain the value of cumulative iron (Fe) dose monitoring for the management of iron therapy in erythropoiesis-stimulating agent (ESA)-treated patients, and the relationship between cumulative iron dose and risk of hospitalization. Methods Demographic, clinical and laboratory parameters from EuCliD ® (European Clinical Dialysis Database) on 3,591 patients were recorded including ESA dose (UI/kg/week), erythropoietin resistance index (ERI) [U.I weekly/kg/gr hemoglobin (Hb)] and hospitalizations. Moreover the cumulative Fe dose (mg/kg of bodyweight) administered over the last 2 years was calculated. Univariate and multivariate analyses were performed to identify the main predictors of ESA resistance and risk of hospitalization. Patients belonging to the 4th quartile of ERI were defined as hypo-responders. Results The 2-year iron cumulative dose was significantly higher in the 4th quartile of ERI. In hypo-responders, 2-year cumulative iron dose was the only iron marker associated with ESA resistance. At case-mix adjusted multivariate analysis, 2-year iron cumulative dose was an independent predictor of hospitalization risk. Discussion In ESA-treated patients cumulative Fe dose could be a useful tool to monitor the appropriateness of Fe therapy and to prevent iron overload. To establish whether the associations between cumulative iron dose, ERI and hospitalization risk are causal or attributable to selection bias by indication, clinical trials are necessary.
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ISSN:1121-8428
1724-6059
1724-6059
DOI:10.1007/s40620-014-0127-3