Residual Renal Function Not Linked to ESA Requirements

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Researchers find no significant difference in the median erythropoietin resistance index between patients with versus without residual renal function.
Researchers find no significant difference in the median erythropoietin resistance index between patients with versus without residual renal function.

Residual renal function (RRF) among patients on chronic dialysis is not associated with reduced requirements for erythropoietin-stimulating agents (ESAs), according to a new study.

Elizabeth Helene Louw and Mogamat-Yazied Chothia, from the Faculty of Medicine and Health Sciences at Stellenbosch University in Cape Town, South Africa, studied 100 patients on chronic dialysis (mean age 41 years). Of these, 36 patients had RRF, which the investigators defined as a 24-hour urine sample volume of 100 mL or greater. Results showed no significant difference in median erythropoietin resistance index (ERI)—which the investigators used as a measure of ESA dose requirements—between those with and without RRF (9.5 vs 11, respectively), according to a paper published in BMC Nephrology (2017;18:336). Louw and Chothia also found no significant difference in median ERI between patients receiving hemodialysis and those receiving peritoneal dialysis (10.8 vs 10.2) or in those using and not using renin-angiotensin system (RAS) blockers (11.6 vs 9.2, respectively).

ERI is defined as the weekly dose of ESA divided by patient weight and corrected for hemoglobin concentration.

In addition, the study found a significantly higher ERI among patients with compared without evidence of systemic inflammation (16.5 vs 9.5).

“Therefore, in those with high ESA dose requirements, an active search for a source of inflammation should be conducted,” the authors concluded.

Reference

Louw EH, Chothia MY. Residual renal function in chronic dialysis is not associated with reduced erythropoietin-stimulating agent dose requirements: a cross-sectional study. BMC Nephrol 2017;18:336.

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