Obese hemodialysis (HD) patients may respond better to therapy with erythropoiesis-stimulating agents (ESAs) than non-obese HD patients, a new study confirms.

Ghada M. El-Kannishy, MD, of Mansoura University in Egypt reviewed the medical records of 733 patients on maintenance HD from 9 centers in Egypt. Nearly a quarter of patients (23%) were obese (body mass index [BMI] of 30 kg/m2 or above). After ESA therapy, similar proportions of non-obese and obese patients reached recommended target hemoglobin levels of 10.0 to 11.5 g/dL (27.3% vs 25.3%, respectively). In addition, median serum ferritin and transferrin saturation levels were not significantly different between groups.

Obese patients required significantly lower weekly ESA doses, however. Patients with lower BMIs tended to need higher ESA doses, and they scored higher on the erythropoietin resistance index (ERI). After multiple linear regression analyses, BMI and urea reduction ratio were the strongest predictors of ERI. The investigators found no significant differences between groups in iron status, hyperparathyroidism, serum albumin levels, creatinine levels, and dialysis adequacy.

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“In conclusion, our study adds to the evidence of obesity-associated advantages,” Dr El-Kannishy and colleagues wrote in Kidney Research and Clinical Practice. “Anemia control was achieved in obese dialysis patients with lower ESA doses.” Prospective studies are still needed to elucidate the mechanisms between higher BMI and lower ESA requirements.

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El-Kannishy GM, Megahed AF, Tawfik MM, et al. Obesity may be erythropoietin dose-saving in hemodialysis patients. Kidney Res Clin Pract 37:148-156. DOI: 10.23876/j.krcp.2018.37.2.148