Role of inflammation, nutritional status and body mass index in the development of resistance to erythropoiesis-stimulating agents (ESAs) in patients under regular hemodialysis | ||||
| African Journal of Biological Sciences | ||||
| Volume 20, Issue 2, June 2024, Page 1-16 PDF (238.23 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ajbs.2024.360954 | ||||
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| Authors | ||||
Samia El-Shishtawy  1; Tamer Abdeltawab2; Farida M Khanany3; Enas Osman3; Anas Ibrahim4
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| 1Nephrology Department, Theodor Bilharz Research Institute, Giza, Egypt | ||||
| 2Department of Nephrology, Theodor Bilharz Research Institute, Giza, Egypt | ||||
| 3Department of Clinical Chemistry, Theodor Bilharz Research Institute, Giza, Egypt | ||||
| 4- Department of Nephrology, Theodor Bilharz Research Institute, Giza, Egypt | ||||
| Abstract | ||||
| Renal anemia in chronic kidney disease (CKD) is a common complication in hemodialysis patients, primarily due to erythropoietin (EPO) and iron deficiencies. EPO is the preferred treatment for renal anemia. A reduction in the efficacy of EPO, referred to as EPO hyporesponsiveness, could be linked to nutritional deficiencies, heightened inflammatory states, and an elevated risk of mortality. The current study aims to elucidate the correlation between the inflammatory biomarkers (high-sensitive C-reactive protein [hs-CRP] and all of the Erythropoietin Resistance Index (ERI), tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]), nutritional indicators (serum albumin, body mass index [BMI] and normalized protein catabolic rate [nPCR]). Methods: The study involved 60 participants (35 males, 25 females; mean age 48.78 ± 14.60 years) who were subjected to consistent hemodialysis treatments over a period exceeding six months, conducted three times per week, within the Nephrology Department at the Theodor Bilharz Research Institute. Medical history and the physical examinations were documented. EPO dosage (units/week) was recorded, and BMI (kg/m²) was calculated. Serum TNF-α and IL-6 levels were measured using the ELISA method. The results indicated that the mean BMI was 26.21 ± 7.18. Primary causes of renal failure included glomerulonephritis (13.33%), diabetic nephropathy (36.67%), hypertension (25%), polycystic kidney disease (3.33%), and unknown causes (21.67%). The mean duration of dialysis was 8.78 ± 3.11 years. Key lab values included Hb 11.35 ± 1.32, transferrin saturation 35.10 ± 11.88, ferritin 572.01 ± 259.68, serum albumin 3.91 ± 0.39, intact parathyroid hormone (iPTH) 575.56 ± 356.17, serum calcium 8.96 ± 0.78, serum phosphorus 5.72 ± 1.88, and URR 73.97 ± 8.71. Significant inverse correlations were found between ERI and BMI, serum creatinine, hemoglobin, serum albumin and nPCR. Also there was positive correlation between ERI and hs-CRP. Conclusion: It was concluded from the results that EPO hyporesponsiveness is associated with low BMI, serum albumin, nPCR, and high hs-CRP levels. No linkage was established between the ERI and the duration of dialysis sessions. | ||||
| Keywords | ||||
| Erythropoietin hyporesponsiveness; Erythropoietin resistance index; Body mass index; Hemodialysis | ||||
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