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Abstract: TH-PO958

High Hemoglobin and High ESA Responsiveness Are Good Prognostic Factors in CKD Patients: An Attribute-Based Analysis Using a Cross-Classification Approach in the BRIGHTEN Study

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Kataoka, Hiroshi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Hayashi, Terumasa, Osaka Kyuseiki Sogo Iryo Center, Osaka, Osaka, Japan
  • Nangaku, Masaomi, Tokyo Daigaku Daigakuin Igakukei Kenkyuka Naikagaku Senko, Bunkyo-ku, Tokyo, Japan
  • Narita, Ichiei, Niigata Daigaku, Niigata, Niigata, Japan
  • Kagimura, Tatsuo, Iryo Innovation Suishin Center, Kobe, Hyogo, Japan
  • Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Hoshino, Junichi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

The BRIGHTEN study, a multicenter, prospective, observational study for patients with non-dialysis-dependent chronic kidney disease with renal anemia, reported the initial erythropoiesis-stimulating agent (ESA) response index (iEResI) to be positively associated with male sex, low hemoglobin (Hb) and iron supplementation, and darbepoetin alfa (DA) administration frequency, suggesting that the iEResI could associated with 'adequacy of anemia treatment'.


We analyzed the data for the 1,480 patients registered in the BRIGHTEN study. The primary outcome was progression of renal dysfunction. The iEResI was calculated by dividing Hb changes resulting from 12-week DA administration by the weight-adjusted total dose of DA administered in that period. Cross-classification (4 groups) of sex × 65 years was used for analysis per attribute.


The baseline Hb levels were similar in all groups, ranging between 9.7–9.9 g/dL, regardless of sex or age. The DA dose/kg was the lowest in men <65 years (0.80 μg/kg/12 weeks) and the highest in women >65 years (1.08 μg/kg/12 weeks), whereas iEResI was the highest in men <65 years (0.61) and the lowest in women >65 years (0.45). The Kaplan–Meier survival curves indicated that men <65 years and women >65 years had the worst and best renal prognoses, respectively, among the cross-classified sub-cohorts. Multivariate Cox analyses in the present study revealed that high levels of Hb (hazard ratio [HR] 0.75, P<0.001) and high levels of iEResI (HR 0.77, P=0.002) were associated with good renal prognosis. Notably, when divided into four subgroups for cross-classification, anemia was associated with renal prognosis in three subgroups: men <65 years, men >65 years, and women >65 years, whereas iEResI was associated with renal prognosis only in men <65 years. In men <65 years, iEResI (HR 0.63, P=0.030), Hb (HR 0.65, P<0.001), eGFR (HR 0.91, P<0.001), and urinary protein excretion (HR 1.12, P<0.001) were associated with renal prognosis.


Anemia and ESA response index (iEResI) were associated with renal prognosis, suggesting that anemia treatment may improve renal prognosis. Cross-classification clarified that men <65 years may benefit more from anemia treatment than other patients.