Minor Elevation in C-Reactive Protein Levels Predicts Incidence of Erythropoiesis-Stimulating Agent Hyporesponsiveness among Hemodialysis Patients

Nephron
Miho KimachiShunichi Fukuhara

Abstract

Hemodialysis (HD) patients occasionally experience minor asymptomatic elevation in C-reactive protein (CRP) levels, which may be associated with difficulty in managing renal anemia using erythropoiesis-stimulating agents (ESAs). Here, we assessed whether elevation of CRP predicts future incidences of ESA hyporesponsiveness. A total of 2,956 HD patients lacking ESA hyporesponsiveness and infectious diseases were enrolled, and the association between CRP levels and incidence of ESA hyporesponsiveness was assessed. CRP levels were divided into 4 categories (normal [<1.0 mg/l], mild [1.0 ≤ CRP <3.0 mg/l], moderate [3.0 ≤ CRP <10.0 mg/l] and high [≥ 10.0 mg/l]). The primary outcome was the cumulative incidence of ESA hyporesponsiveness, defined as a failure to achieve hemoglobin level ≥ 10 g/dl despite receiving high doses of ESAs (≥ 9,000 U/week recombinant human epoetin [rHuEPO]-α or rHuEPO-β and ≥ 60 μg/week darbepoetin-α) during 12 months of follow-up. The cumulative incidence of ESA hyporesponsiveness was 134 (4.8%) occurrences over 4 months and 300 (12.4%) over 12 months. The elevated CRP groups had significantly higher incidence of ESA hyporesponsiveness over 4 months of follow-up than the normal reference group (adjusted rel...Continue Reading

Citations

Jun 1, 2017·American Journal of Nephrology·Takeshi HasegawaMasaomi Nangaku
Sep 19, 2019·The New England Journal of Medicine·Tomas Ganz
Jul 28, 2020·Pharmacology Research & Perspectives·Francisca Johanna van den OeverYvonne C Schrama
Jul 22, 2018·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Rachel GavishIrit Krause
Nov 18, 2020·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Tadao AkizawaMichael Reusch
Dec 5, 2021·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Eiko UedaKouichi Tamura

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