Kidney Res Clin Pract.  2018 Jun;37(2):148-156. 10.23876/j.krcp.2018.37.2.148.

Obesity may be erythropoietin dose-saving in hemodialysis patients

• El-Kannishy GM
• Megahed AF
• Tawfik MM
• El-Said G
• Zakaria RT
• Mohamed NA
• Taha EM
• Ammar AA
• Abd Eltawab AM
• Sayed-Ahmed NA

• KMID: 2416083
• DOI: http://doi.org/10.23876/j.krcp.2018.37.2.148

Abstract

BACKGROUND
In dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt.
METHODS
This multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated.
RESULTS
Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0-11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI.
CONCLUSION
Our study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.

Keyword

Body mass index; Erythropoiesis-stimulating agents; Obesity; Renal Dialysis

MeSH Terms

Anemia
Body Mass Index
Dialysis
Egypt
Erythropoietin*
Ferritins
Humans
Iron
Linear Models
Obesity*
Observational Study
Renal Dialysis*
Transferrin
Urea
Erythropoietin
Ferritins
Iron
Transferrin
Urea