The influencing factors of the erythropoietin resistance index and its association with all-cause mortality in maintenance hemodialysis patients

Abstract

Anemia is a common complication of chronic kidney disease with major option treatment of erythropoiesis-stimulating agents (ESAs). This study aimed to investigate the influencing factors of erythropoietin resistance index (ERI) and its association with mortality in maintenance hemodialysis (MHD) patients. Patients enrolled from China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5 were included. ERI was calculated as follows: ESA (IU/week)/weight (kg, post-dialysis)/hemoglobin level (g/dL). The Cox regression model was used to analyze the influencing factors on survival outcomes. Stepwise multivariate logistic regression was used to identify the related risk factors, and subgroup analyses were performed. A total of 1270 MHD subjects (687 males and 583 females) were included, with an average age of 60 (49.0, 71.0) years. All subjects were divided into two groups by the median ERI of 14.03. Multivariate logistic regression showed that dialysis vintage (OR 0.957, 95% CI: 0.929–0.986), white blood cells (OR 0.900, 95% CI: 0.844–0.960), high flux dialyzer use (OR 0.866, 95% CI: 0.755–0.993), body mass index (OR 0.860, 95% CI: 0.828–0.892), males (OR 0.708, 95% CI: 0.625–0.801), and albumin (OR 0.512, 95% CI: 0.389–0.673) had a negative association with high ERI baseline (all p < 0.05). There were 176 (13.9%) deaths in total including 89 cardiac/vascular deaths during follow-up. Cox regression analysis showed that ERI was positively associated with all-cause mortality, especially in some subgroups. ERI was associated with increased all-cause mortality in MHD patients, indicating the possibility of death prediction by ERI. Patients with high ERI warrant more attention.

Keywords:

• Anemia
• maintenance hemodialysis
• erythropoietin resistance index
• mortality

Acknowledgements

The Dialysis Outcomes and Practice Patterns Study (DOPPS) Program in China is supported by Vifor Fresenius Renal Pharma, Sanofi Renal, Nipro Trading (Shanghai) Co., Ltd., 3SBio Inc., B. Braun, CEMMA MEDICAL, and Kyowa Kirin China Pharmaceutical Co., Ltd.

Ethical approval

The study was approved by the Ethics Committee of Peking University People’s Hospital (ethical approval number: 2018PHB028-01). Other participating subcenters also obtain ethics committee approval documents prior to the start of clinical trials.

Consent form

All patients signed the written informed consent.

Author contributions

Conception and design of research: Xinju Zhao and Li Zuo; analyzed data: Xinju Zhao; interpreted results of experiments: Xinju Zhao and Li Zuo; prepared figures: Xinju Zhao; drafted manuscript: Xinju Zhao; edited and revised manuscript: Liangying Gan, Fan Fan Hou, Xinling Liang, Zhaohui Ni, Xiaonong Chen, Yuqing Chen, and Li Zuo; approved final version of manuscript: Li Zuo.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data used in this study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was supported by Beijing Natural Science Foundation [No.7222201] and Research Project of Blood Purification Center Branch of Chinese Hospital Association (No. CHABP2021-11), the grant recipients are Li Zuo, and Xinju Zhao, respectively.