Body composition affects the response to erythropoiesis-stimulating agents in patients with chronic kidney disease in dialysis

Figures & data

Table 1. Descriptive characteristics for the study population.

	TOTAL (N = 218)	HD (N = 176)	PD (N = 42)	p
Age (years)	65 (16)	66 (15)	58 (17)	0.01
BMI (kg/m^2)	26.3 (5.2)	26.3 (5.5)	26.1 (3.9)	NS
FTI (kg/m^2)	12.6 (6.2)	13.1 (6.5)	10.4 (4.2)	0.002
LTI (kg/m^2)	13.2 (3.7)	12.8 (3.7)	15.2 (3.1)	0.001
CRP* (mg/dL)	0.6 (0.2–1.2)	0.7 (0.4–1.2)	0.5 (0.2–0.9)	NS
Albumin (g/dL)	4.0 (0.5)	4.0 (0.5)	3.8 (0.4)	0.02
Prealbumin (mg/dL)	30.6 (9.5)	29.6 (9.6)	35.1 (7.7)	0.01
ESR first hour (mm)	28.5 (21.7)	32.1 (24.2)	26.5 (19.2)	NS
Fibrinogen (mg/dL)	472.3 (111.4)	495.2 (121.0)	440.0 (108.5)	NS
Ferritin (µg/L)	183.4 (69.8)	165.0 (55.2)	204.2 (78.9)	NS
Serum iron (µg/dL)	90.5 (39.0)	75(25.4)	104.5 (40.5)	NS
Saturation transferrin (%)	35 (10.0)	34 (9.8)	36 (10.1)	NS
ERI (UI/Kg/week/(g/dL))* (′) (N = 182)	5.5 (2.7–10.1)	10.6 (4.8–13.1) (N = 151)	4.7 (2.3–9.6) (N = 31)	0.02
LVEF (%)	50 (10)	50(10)	50(10)	NS
LVMI (g/m^2)	120 (32)	134(43)	102(34)	NS

Notes: Results expressed as mean and standard deviation.

HD, hemodialysis; PD, peritoneal dialysis; BMI, body mass index; FTI, fat tissue index; LTI, lean tissue index; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; ERI, erythropoietin resistance index; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; NS, no significant.

*Results expressed as median and interquartilic range (percentile 25–percentile 75). The rest of the results are shown as mean and standard deviation. In this case, the sample size is only from the patients receiving treatment with ESA.

The statistic significance of p corresponds to the differences between HD and PD groups.

Figure 1. Correlation between body mass index and fat tissue index. Y = 0.65x + 18.5. R Pearson = 0782. p = 0.001.

Figure 2. Correlation between body mass index and erythropoietin resistance index. Y = −0.3x + 13.3. R Spearman = −0.161. p = 0.03.

Table 2. Correlation (Rho Spearman test) between ERI and the other variables in patients receiving ESA (N = 182).

	R	p
Age (years)	−0.71	NS
BMI (kg/m^2)	−0.222	0.01
FTI (kg/m^2)	−0.193	0.01
LTI (kg/m^2)	−0.035	NS
Albumin (g/dL)	−0.115	NS
Prealbumin (mg/dL)	−0.145	0.04
Fibrinogen (mg/dL)	−0.059	NS
ESR first hour (mm)	0.125	NS
CRP (mg/dL)	−0.02	NS
LVEF (%)	0.110	NS
LVMI (g/m^2)	0.239	NS
Ferritin (µg/L)	0.210	NS
Saturation transferrin (%)	0.439	NS

Notes: Results are expressed as r coefficient of the correlation.

ESA, erythropoiesis stimulating agents; BMI, body mass index; FTI, fat tissue index; LTI, lean tissue index; ESR, erythrocyte sedimentation rate; CRP, C reactive protein; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; NS, no significant.

Table 3. Univariate association between patients with ERI < 10.1 and  > 10.1 (IU/week/kg/Hb concentration [g/dL]) in those receiving ESA (N = 182).

	ERI < 10.1 (N = 119)	ERI > 10.1 (N = 63)	p
Age (years)	66 (14)	60 (17)	0.02
BMI (kg/m^2)	27.0 (5.4)	24.5 (4.3)	0.001
FTI (kg/m^2)	13.3 (6.5)	10.8 (4.9)	0.003
LTI (kg/m^2)	13.5 (3.5)	13.1 (4.2)	NS
Prealbumin (mg/dL)	32.0 (8.5)	27.4 (10.9)	0.002
Albumin (g/dL)	4.0 (0.5)	3.9 (0.5)	NS
CRP* (mg/dL)	0.6 (0.3–1.0)	0.7 (0.4–1.2)	NS
ESR first hour (mm)	28.9 (22.7)	30.1 (24.0)	NS
Ferritin (µg/l)	182.2 (70.8)	179.5 (67.9)	NS
Saturation transferrin (%)	35.0 (10.0)	34.9 (10.0)	NS

Notes: ESA, erythropoiesis stimulating agents; BMI, body mass index; FTI, fat tissue index; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; LTI, lean tissue index.

Results expressed as mean and standard deviation.

Table 4. Multivariate binary logistic regression analysis among patients with ERI > > 10.1 (IU/week/kg/Hb).

	B	p	OR (IC 95%)
Age (years)	−0.028	0.08	0.972 (0.951–1.003)
BMI (kg/m^2)	−0.05	0.51	1.051 (0.905–1.220)
FTI (kg/m^2)	−0.111	0.04	0.895 (0.800–0.998)
LTI (kg/m^2)	0.076	0.948	1.005 (0.877–1.116)
Prealbumin (mg/dL)	−0.056	0.003	0.946 (0.911–0.981)
Dialysis technique (HD vs. PD)	−0.631	0.008	0.196 (0.058–0.696)

Notes: Results expressed as slope (B), p and odds ratio (OR) interval confidence 95% (IC 95%).

BMI, body mass index; FTI, fat tissue index; LTI, lean tissue index; HD, hemodialysis; PD, peritoneal dialysis.