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Natavee Chaitham:Hyporesponsiveness of Erythropoietin-Stimulating Agents and Factors Associated in Peritoneal Dialysis Patients PPT讲座视频 The 8th Asia Pacific Chapter Meeting of International Society for Peritoneal Dialysis (APCM-ISPD 2017)
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标题： Hyporesponsiveness of Erythropoietin-Stimulating Agents and Factors Associated in Peritoneal Dialysis Patients
讲者： Natavee Chaitham
单位： Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Thailand
关键词：
Erythropoietin-stimulating agent hyporesponsiveness predictors risk factors
播放： 1431
论文摘要： Background Hyporesponsiveness to erythropoietin-stimulating agents (ESAs) is a known predictor of poorer clinical outcomes in dialysis patients. To date, studies of factors related ESAs hyporesponsiveness among peritoneal dialysis (PD) patients are limited.
Objectives To identify factors associated with ESAs hyporesponsiveness among PD patients.
Methods A retrospective observational study was based on the PD registry database at the Kidney Center, General hospital, Chiang Mai, Thailand. PD patients aged > 18 and treated with ESAs > 90 days were included. Clinical and laboratory examination characteristics were collected between January, 2008, and December, 2014. ESAs hyporesponsiveness, defined as the erythropoietin-resistance index (ERI) > 11.2 (the 80th percentile), calculated as a weekly weight-adjusted dose of ESAs divided by the hemoglobin level. Predictors related to ESAs hyporesponsiveness were analyzed by univariable and multivariable logistic regression.
Results A total of 302 PD patients (mean age of 58.7 + 12.0 years; 52.6% men) were included. Of those, 90 (29.8%) patients were identified as having ESAs hyporesponsiveness. The multivariable logistic regression model explained 74.1% of the probability of ESAs hyporesponsiveness. Four independent significant risk factors of ESAs hyporesponsiveness were renal diagnosis with hypertension (adjusted odd ratios [OR] 2.61; 95% confidence interval [CI], 1.23-5.56) and other causes (adjusted OR 2.61; 1.04-6.56); increasing scores of Charlson’s comorbidity index with 5-6 (adjusted OR 2.99; 1.42-6.28) and over 6 (adjusted OR 5.07; 1.83-14.01); the Geriatric Nutrition Risk Index below 80 (adjusted OR 2.69; 1.18-6.12); and increasing values of platelet-to-lymphocyte ratio: levels of 120-220 (adjusted OR 5.96; 2.12-16.75) and over 220 (adjusted OR 7.94; 2.65-23.77).
Conclusions Severe medical illness and poor nutritional status are more frequently found in PD patients with ESAs hyporesponsiveness. They may be signs of a subgroup at risk of malnutrition-inflammation complex syndrome, and seem to be important for early identification to help targeting ESAs hyporesponsive patients.
 
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