Association of malnutrition-inflammation complex and responsiveness to erythropoiesis-stimulating agents in long-term hemodialysis patients

作者：Rattanasompattikul Manoch; Molnar Miklos Z; Zaritsky Joshua J; Hatamizadeh Parta; Jing Jennie; Norris Keith C; Kovesdy Csaba P; Kalantar Zadeh Kamyar^*

来源：Nephrology Dialysis Transplantation, 2013, 28(7): 1936-1945.

DOI：10.1093/ndt/gfs368

• erythropoietin-stimulating agent (ESA) therapy
• hemoglobin
• inflammatory marker
• malnutrition-inflammation complex
• responsiveness to ESAs

Background. Protein-energy wasting, inflammation and refractory anemia are common in long-term hemodialysis patients. A decreased responsiveness to erythropoiesis-stimulating agents (ESA) is often the cause of the refractory anemia. We hypothesized that the malnutrition-inflammation complex is an independent predictor of decreased responsiveness to ESAs in hemodialysis patients. %26lt;br%26gt;Methods. This cohort study of 754 hemodialysis patients was examined for an association between inflammatory and nutritional markers, including the malnutrition-inflammation score (MIS) and responsiveness to ESA. Cubic spline models were fitted to verify found associations. %26lt;br%26gt;Results. The mean (+/- SD) age of patients was 54 +/- 15 years, 53% were diabetic and 32% blacks. MIS was worse in the highest quartile of ESAs responsiveness index (ERI, ESA dose divided by hemoglobin) when compared with 1st quartile (6.5 +/- 4.5 versus 4.4 +/- 3.4; P %26lt; 0.001). Both C-reactive protein (log CRP) (beta = 0.19) and interleukin-6 (log IL-6) (beta = 0.32) were strong and independent predictors of ERI using multivariate linear regression. Serum albumin (beta = -0.30) and prealbumin levels (beta = -0.14) were inversely associated with ERI. Each 1 SD higher MIS, higher CRP and lower albumin were associated with 86, 44 and 97% higher likelihood of having highest versus three lowest ERI quartiles in fully adjusted models [odds ratio (and 95% confidence interval) of 1.86 (1.31-2.85), 1.44 (1.08-1.92) and 1.97 (1.41-2.78)], respectively. Cubic splines confirmed the continuous and incremental nature of these associations. %26lt;br%26gt;Conclusions. Malnutrition-inflammation complex is an incremental predictor of poor responsiveness to ESAs in hemodialysis patients. Further studies are needed to assess whether modulating inflammatory or nutritional processes can improve anemia management.

• 出版日期2013-7