In anemic patients on hemodialysis (HD), having autoantibodies to the erythropoietin receptor (EPOR) may contribute to hyporesponsiveness to erythropoiesis-stimulating agents (ESA), according to investigators.

Of 108 Japanese patients on HD from 3 institutions (mean age 68 years; 69% male; 57% diabetic; median dialysis vintage 58 months), anti-EPOR antibodies were detected in 11, Akinori Hara, MD, PhD, of Kanazawa University Hospital in Kanazawa, Japan, and colleagues reported in Clinical and Experimental Nephrology.

The ESA resistance index (ERI) was higher in patients with vs without anti-EPOR antibodies: 17.83 vs 7.12. Patients with the antibodies had a lower body mass index (BMI) and lower serum albumin but higher C-reactive protein (CRP). In univariate analyses, higher ERI correlated with worse clinical characteristics (lower BMI and levels of hemoglobin, platelet, magnesium, and ferritin) and greater inflammation as indicated by CRP levels. On multivariate analysis, anti-EPOR antibodies and CRP emerged as significant risk factors for ESA hyporesponsiveness, defined as an ERI of 13.9 or higher. The researchers adjusted for sex, age, use of renin angiotensin system inhibitors, Kt/V, ferritin, intact parathyroid hormone, magnesium, and other variables.

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This report is the first to show an independent relationship between serum anti-EPOR antibodies and ESA hyporesponsiveness in patients on maintenance HD, according to Dr Hara’s team.

“Although there may be a lack of treatment options for anti-EPOR antibodies in some patients, such as those without an indication for immunosuppressive therapy, their presence could help physicians diagnose ESA hyporesponsiveness and provide hemodialysis patients with individualized anemia management regimens,” they concluded.

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Hara A, Koshino Y, Kurokawa Y, et al. Relationship between anti‑erythropoietin receptor autoantibodies and responsiveness to erythropoiesis‑stimulating agents in patients on hemodialysis: a multi‑center cross‑sectional study [published online September 9, 2019]. Clin Exp Nephrol. doi:10.1007/s10157-019-01787-6