Relationship between protein-energy wasting in adults with chronic hemodialysis and the response to treatment with erythropoietin.

Relación entre el desgaste proteico-energético en adultos en hemodiálisis crónica y la respuesta al tratamiento con eritropoyetina.

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ID: 32499
2019
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Abstract
It is known that one of the leading causes of morbidity in chronic kidney disease (CKD) is the anemic syndrome. Although the pathogenic mechanisms of anemia are multiple, erythropoietin deficiency appears as the dominant factor. Patients in hemodialysis (HD) have a high prevalence of protein energy wasting (PEW) that may explains the poor response to Erythropoietin (EPO).Retrospective cohort study of patients on HD from January to December 2014. The participants were classified according to a diagnostic of PEW using the "Malnutrition Inflammation Score" (MIS) and bioimpedance analysis (BIA) measurement of body composition at the start of erythropoietin therapy and after 3 months of follow up. We performed descriptive statistics and analyzed the differences between groups with and without PEW considering their responsiveness. In addition, we calculated the relative risk of EPO resistance, considering p value < 0.05 as statistically significant.Sixty-one patients ended the follow up. Both groups were similar in basal hemoglobin, hematocrit and other hematopoiesis markers (p = NS). Patients without PEW have a decrease risk for poor response to treatment with EPO (RR = 0.562 [95% CI, 0.329-0.961-]) than those with PEW. Finally, hemoglobin concentrations were evaluated at baseline and every four weeks until week 12, finding a statistically significant improvement only in patients without PEW according MIS (p < 0.05).PEW is an incremental predictor of poor responsiveness to EPO in HD patients, thus, it is important to consider correcting malnutrition or wasting for a favorable response to treatment with EPO.
Se sabe que una de las principales causas de morbilidad en la enfermedad renal crónica (ERC) es el síndrome anémico. Aunque los mecanismos patogénicos de la anemia son múltiples, la deficiencia de eritropoyetina parece ser el factor predominante. Los pacientes en hemodiálisis (HD) presentan una alta prevalencia de desgaste proteico-energético (DPE), lo que podría explicar la escasa respuesta a la eritropoyetina (EPO). Estudio de cohorte retrospectivo de pacientes en HD de enero a diciembre de 2014. Los participantes se clasificaron según el diagnóstico de DPE mediante el «Malnutrition Inflammation Score» (MIS) y la medición de la composición corporal por análisis de bioimpedancia (BIA) al inicio del tratamiento con eritropoyetina y tras 3 meses de seguimiento. Se realizó estadística descriptiva y se analizaron las diferencias entre los grupos con y sin DPE considerando su grado de respuesta. Además, se calculó el riesgo relativo de resistencia a la EPO, considerando un valor de p < 0,05 como estadísticamente significativo. Sesenta y un pacientes completaron el seguimiento. Ambos grupos fueron similares en cuanto a hemoglobina basal, hematocrito y otros marcadores de hematopoyesis (p = NS). Los pacientes sin DPE tuvieron un menor riesgo de mala respuesta al tratamiento con EPO (RR = 0,562 [IC 95 %, 0,329-0,961]) que aquellos con DPE. Por último, se evaluaron las concentraciones de hemoglobina al inicio y cada cuatro semanas hasta la semana 12, encontrándose una mejoría estadísticamente significativa únicamente en los pacientes sin DPE según el MIS (p < 0,05). El DPE es un predictor incremental de una baja respuesta a la EPO en pacientes en HD; por lo tanto, es importante considerar la corrección de la desnutrición o el desgaste para obtener una respuesta favorable al tratamiento con EPO.
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gonzlezortiz2019relationshipbmc Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors González-Ortiz, Ailema;Correa-Rotter, Ricardo;Vázquez-Rangel, Armando;Vega-Vega, Olynka;Espinosa-Cuevas, Ángeles;
Journal bmc nephrology
Year 2019
DOI
10.1186/s12882-019-1457-0
URL
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