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360954

Role of inflammation, nutritional status and body mass index in the development of resistance to erythropoiesis-stimulating agents (ESAs) in patients under regular hemodialysis

Article

Last updated: 25 Dec 2024

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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.

DOI

10.21608/ajbs.2024.360954

Keywords

Erythropoietin hyporesponsiveness, erythropoietin resistance index, Body Mass Index, Hemodialysis

Authors

First Name

Samia

Last Name

El-Shishtawy

MiddleName

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Affiliation

Nephrology Department, Theodor Bilharz Research Institute, Giza, Egypt

Email

samya_shishtawy@yahoo.com

City

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Orcid

-

First Name

Tamer

Last Name

Abdeltawab

MiddleName

-

Affiliation

Department of Nephrology, Theodor Bilharz Research Institute, Giza, Egypt

Email

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City

-

Orcid

-

First Name

Farida

Last Name

Khanany

MiddleName

M

Affiliation

Department of Clinical Chemistry, Theodor Bilharz Research Institute, Giza, Egypt

Email

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City

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Orcid

-

First Name

Enas

Last Name

Osman

MiddleName

-

Affiliation

Department of Clinical Chemistry, Theodor Bilharz Research Institute, Giza, Egypt

Email

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City

-

Orcid

-

First Name

Anas

Last Name

Ibrahim

MiddleName

-

Affiliation

- Department of Nephrology, Theodor Bilharz Research Institute, Giza, Egypt

Email

anaskhalil1984@yahoo.com

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-

Orcid

-

Volume

20

Article Issue

2

Related Issue

48538

Issue Date

2024-06-01

Receive Date

2024-04-12

Publish Date

2024-12-25

Page Start

1

Page End

16

Print ISSN

1687-4870

Online ISSN

2314-5501

Link

https://ajbs.journals.ekb.eg/article_360954.html

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https://ajbs.journals.ekb.eg/service?article_code=360954

Order

360,954

Type

Original Article

Type Code

1,101

Publication Type

Journal

Publication Title

African Journal of Biological Sciences

Publication Link

https://ajbs.journals.ekb.eg/

MainTitle

Role of inflammation, nutritional status and body mass index in the development of resistance to erythropoiesis-stimulating agents (ESAs) in patients under regular hemodialysis

Details

Type

Article

Created At

25 Dec 2024