Background: Responsiveness to erythropoiesis-stimulating agents (ESAs) varies widely among dialysis patients. ESA\r\nresistance has been associated with mortality in hemodialysis (HD) patients, but in peritoneal dialysis (PD) patients\r\ndata is limited. Therefore we assessed the relation between ESA resistance in both HD and PD patients.\r\nMethods: NECOSAD is a Dutch multi-center prospective cohort study of incident dialysis patients who started\r\ndialysis between January 1997 and January 2007. ESA resistance was defined as hemoglobin level < 11 g/dL with an\r\nabove median ESA dose (i.e. 8,000 units/week in HD and 4,000 units/week in PD patients). Unadjusted and adjusted\r\nCox regression analysis for all-cause 5-year mortality was performed for HD and PD patients separately.\r\nResults: 1013 HD and 461 PD patients were included in the analysis. ESA resistant HD patients had an adjusted\r\nhazard ratio of 1.37 (95% CI 1.04-1.80) and ESA resistant PD patients had an adjusted hazard ratio of 2.41 (1.27-4.57)\r\nas compared to patients with a good response.\r\nConclusions: ESA resistance, as defined by categories of ESA and Hb, is associated with increased mortality in both\r\nHD and PD patients. The effect of ESA resistance, ESA dose and hemoglobin are closely related and the exact\r\nmechanism remains unclear. Our results strengthen the need to investigate and treat causes of ESA resistance not\r\nonly in HD, but also in PD patients.
Loading....