Feret Wiktoria, Safranow Krzysztof, Ciechanowski Kazimierz, Kwiatkowska Ewa
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-001 Szczecin, Poland.
Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-001 Szczecin, Poland.
J Clin Med. 2022 Apr 26;11(9):2426. doi: 10.3390/jcm11092426.
Background: Anemia is the most common finding in patients with end-stage kidney disease undergoing renal replacement therapy. A certain percentage of patients does not respond adequately to erythropoietin (EPO) treatment, not being able to reach desirable hemoglobin levels even when treated with large-dose EPO and intravenous/oral iron. In our study, we wanted to further investigate how nutritional status is associated with erythropoietin responsiveness. To quantify EPO response, we used the Erythropoietin Resistance Index (ERI), which is defined as the weekly weight-adjusted dose of EPO divided by the hemoglobin level. Patients and methods: Seventy-eight patients undergoing hemodialysis were included. All of them were measured by a SECA mBCA body composition analyzer and evaluated by Kalantar-Zadeh’s MIS score. Routine biochemical tests were also taken into account. The Shapiro-Wilk test was used to study the distributions of quantitative variables, which were significantly different from normal (p < 0.05). We used nonparametric Mann-Whitney U-test to compare groups. Correlations were studied by means of Spearman’s rank correlation coefficient. Bonferroni correction for multiple testing was performed. To find independent determinants of ERI, we additionally performed multivariate analysis using the General Linear Model (GLM). Results: In terms of body composition, factors that are associated with high ERI are low BMI, low fat mass, low visceral fat volume, high total body water percentage, low phase angle and low fat-free mass. In addition to body composition parameters, total MIS score and IL-6 serum levels correlated positively with ERI value. IL-6 was an independent determinant of ERI value, based on multivariate analysis. After correction for multiple analysis, BMI and eGFR both remained significant factors associated with EPO response. Conclusions: It seems crucial to prevent inflammatory malnutrition as a part of a holistic approach to anemia treatment in dialysis patients.
贫血是接受肾脏替代治疗的终末期肾病患者最常见的表现。一定比例的患者对促红细胞生成素（EPO）治疗反应不佳，即使使用大剂量EPO和静脉注射/口服铁剂治疗，也无法达到理想的血红蛋白水平。在我们的研究中，我们想进一步探讨营养状况与促红细胞生成素反应性之间的关系。为了量化EPO反应，我们使用了促红细胞生成素抵抗指数（ERI），其定义为每周体重调整后的EPO剂量除以血红蛋白水平。
纳入78例接受血液透析的患者。所有患者均使用SECA mBCA人体成分分析仪进行测量，并通过卡兰塔尔 - 扎德的MIS评分进行评估。还考虑了常规生化检查。使用夏皮罗 - 威尔克检验研究定量变量的分布，这些变量与正态分布有显著差异（p < 0.05）。我们使用非参数曼 - 惠特尼U检验比较组间差异。通过斯皮尔曼等级相关系数研究相关性。对多重检验进行了邦费罗尼校正。为了找到ERI的独立决定因素，则使用广义线性模型（GLM）进行多变量分析。
在身体成分方面，与高ERI相关的因素包括低体重指数、低脂肪量、低内脏脂肪体积、高总体水百分比、低相位角和低去脂体重。除身体成分参数外，总MIS评分和IL - 6血清水平与ERI值呈正相关。基于多变量分析，IL - 6是ERI值的独立决定因素。在进行多重分析校正后，体重指数和估算肾小球滤过率均仍然是与EPO反应相关的显著因素。
作为透析患者贫血治疗整体方法的一部分，预防炎症性营养不良似乎至关重要。
