Response to ESAs Predicts ESRD Risk

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PHILADELPHIA—Patients with chronic kidney disease (CKD) who have a low response to erythropoiesis-stimulating agents (ESAs) are at increased risk of progressing to end-stage renal disease (ESRD), investigators reported at Kidney Week 2011.

In a study of 194 CKD patients not on dialysis, those in the lowest tertile of ESA response had a 2.46 times increased risk of ESRD and a 2.61 times increased risk of renal death (ESRD or death) compared with those in the highest tertile, after adjusting for age, gender, body mass index, and other potential confounders.

During a median follow-up of 2.9 years, ESRD developed in 99 patients and 35 died. During the initial six months, the number of months in which hemoglobin (Hb) levels were below 11 g/dL was 4.0, 1.5, and 0.8 in patients in the first, second, and third tertiles of ESA responsiveness, respectively. The mean ESA dose was 23.9, 23.5 and 17.2 µg per week, respectively.

The researchers, led by Roberto Minutolo, MD, of the Second University of Naples in Italy, said the findings point to a potential role for persistent hypoxia in patients with more advanced renal damage.

“Our results support the suggestion to consider not only achievement of Hb target, but also ESA responsiveness as a valuable tool in anemia management by extending its prognostic usefulness from cardiovascular to renal risk,” Dr. Minutolo said.

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