Anemia More Severe in Hemodialysis Patients with PEW

Patients with vs. without protein-energy wasting syndrome had a significantly lower mean hemoglobin level.
Patients with vs. without protein-energy wasting syndrome had a significantly lower mean hemoglobin level.

SAN DIEGO—Hemodialysis (HD) patients with protein-energy wasting syndrome (PEW) have significantly lower hemoglobin levels and increased erythropoietin requirements than those without PEW, according to the results of an observational comparative study presented at Kidney Week 2015.

The study, by Carlos Adrián Chávez-Mendoza, MD, and colleagues at the National Institute of Medical Science and Nutrition Salvador Zubiran in Mexico City, included 191 HD patients, of whom 41 (22%) had PEW. The mean hemoglobin level was 9.5 mg/dL in the PEW group compared with 10.3 mg/dL in the no-PEW group. The mean erythropoietin requirement was significantly higher in PEW than no-PEW group (171.2 vs. 142.6 U/kg/week), despite no significant differences in iron reserves as reflected in ferritin levels and transferrin saturation. The PEW and no-PEW groups had mean ferritin levels of 463 and 331 ng/mL, respectively, and mean transferrin saturation of 31.7% and 26.1%. 

Compared with the no-PEW group, the PEW group had significantly more overhydration (43.05 vs. 27.39 mL/kg) and extracellular water (263.13 vs. 246.17 mL/kg). In multivariable analysis, degree of overhydration and extracellular water were independent predictors of PEW. The researchers found no impact of PEW on quality of life.

The 2 groups were similar with respect to age, Charlson index, number and type of drugs used, time on dialysis, and vascular access, according to the investigators.

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