Kidney Week

Abstract: SA-PO241

A Faster Decline of Residual Kidney Function and Erythropoiesis-Stimulating Agent (ESA) Hyporesponsiveness in Incident Hemodialysis Patients

Session Information

• Anemia and Iron Metabolism: Clinical
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

• 202 Anemia and Iron Metabolism: Clinical

Authors

• Kimura, Hiroshi, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Hiroshi Kimura,

• Okuda, Yusuke, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, United States

Yusuke Okuda,

• Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Connie Rhee,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,

• Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

In dialysis patients, resistance to ESA is associated with worse outcomes such as higher death risk. Prior studies have demonstrated that a slower loss of residual kidney function (RKF) in the first year of hemodialysis (HD) is associated with improved survival and potentially a healthier profile. However, little is known about the relationship between RKF decline and resistance to ESA.

Methods

The odds of ESA hyporesponsiveness with RKF decline in the first year were examined across four strata of annual changes in residual renal urea clearance ([KRU], <-3.0, -3.0 to <-1.5, -1.5 to <0, ≥0 mL/min/1.73m²) and urinary volume (<-600, -600 to <-300, -300 to <0, ≥0 mL/day). Logistic regression models adjusted for demographic, clinical characteristics and laboratory variables were used in 5,239 incident HD patients from a large US dialysis organization (2007-2011).

Results

The median (interquartile range) baseline values of the annual changes in KRU and urinary volume were -1.2 (-2.8, 0.1) mL/min/1.73m² and -250 (-600, 100) mL/day, respectively. A faster RKF decline in the first year of HD initiation was associated with higher odds of ESA hyporesponsiveness (Figure). These associations remained robust across adjustment for laboratory variables and consistent in subgroup analyses across strata of baseline RKF, age, sex, race, diabetes, congestive heart failure, hemoglobin, and serum albumin. Similar results were found using urinary volume as another index of RKF (Figure).

Conclusion

A faster RKF decline during the first year of dialysis was associated with hyporesponsiveness to ESA among incident HD patients. Future studies are necessary to explain the underlying mechanisms of this association.

Funding

• NIDDK Support