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Abstract: TH-OR030

Association of Erythropoietin Resistance and Fibroblast Growth Factor 23 in Dialysis Patients: Results from the J-DOPPS Study

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Usui, Tomoko, the University of Tokyo School of Medicine, Tokyo, Japan
  • Zhao, Junhui, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Hanafusa, Norio, Tokyo Women's Medical University, Shinjuku-ku, ToKyo, Japan
  • Hasegawa, Takeshi, Showa University, Yokohama, Kanagawa, Japan
  • Fujino, Hiroshi, Kyowa Hakko Kirin, Tokyo, Japan
  • Nomura, Takanobu, Kyowa Hakko Kirin, Tokyo, Japan
  • Zee, Jarcy, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Young, Eric W., Arbor Research, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Nangaku, Masaomi, the University of Tokyo School of Medicine, Tokyo, Japan
Background

High fibroblast growth factor 23 (FGF23) levels are associated with low hemoglobin levels and increased risk of anemia development in non-HD CKD patients. FGF23 negatively regulates erythropoiesis. We hypothesized that higher FGF23 levels would be associated with increased erythropoietin hyporesponsiveness among HD patients.

Methods

This study included 1048 patients from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) phase 5 (2012-2015). The outcome was erythropoiesis-stimulating agent (ESA) hyporesponsiveness, which was defined dichotomously as mean Hgb <10 g/dL and a standardized mean ESA dose >6,000 u/week over the 4 months following FGF23 measurement. The association between ESA hyporesponsiveness and FGF23 was estimated using multivariable adjusted logistic generalized estimating equation (GEE) regression models. We estimated the effect of FGF23 with increasing levels of covariate adjustment in three models for each outcome (See footnote in Figure).

Results

Patients with higher levels of FGF23 were younger and had higher levels of serum albumin, creatinine, albumin-corrected calcium, phosphorus, PTH, 25(OH)-Vitamin D and a higher percentage of IV iron, IV Vitamin D and cinacalcet use. ESA hyporesponsiveness was found in 144 patients (13.7%). Compared with the 3rd quintile of FGF23 levels, patients had increased risk of ESA hyporesponsiveness in the first (odds ratio [OR]=2.10, 95% confidence interval [CI]: 0.97-4.58) and fifth quintiles (OR=1.79, 95% CI: 0.79-4.04).

Conclusion

The lowest and highest levels of FGF23 were associated with increased ESA hyporesponsiveness in patients on maintenance HD.

Funding

  • Commercial Support