MO901ASSOCIATION OF MALNUTRITION AND INFLAMMATION WITH ERYTHROPOIETIN RESISTANCE INDEX. (29th May 2021)

• Record Type: Journal Article
• Authors: Sá Martins, Vitor; Adragao, Teresa; Aguiar, Leila; Dias, Catarina; Figueiredo, Rita; Lourenço, Pedro; Pascoal, Tania; Pereira, Juliana; Pinheiro, Tatiana; Ramião, Inês; Velez, Brígida; Borges, Nuno; Calhau, Conceição; Macário, Fernando
• Is Part Of: Nephrology dialysis transplantation. Volume 36(2021)Supplement 1
• Publication Date: 2021-05-29
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfab102.002
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background and Aims: Erythropoietin Resistance Index (EPORI) has been previously associated with higher risk of mortality and morbidity in hemodialysis (HD) patients (pts). The objectives of this study were to identify which factors, such as the risk of malnutrition, are associated with EPORI and to assess its association with mortality and hospitalization risk. Method: Historical cohort study in a group of high-flux HD pts from 25 outpatient HD clinics, starting from a baseline group of 2975 pts. We evaluated EPORI, interdialytic weigh gain (IDWG), Malnutrition Inflammation Score (MIS) and the other parameters at the study baseline. For a better understanding of weight gain patterns, we calculated the average of the IDWG at the day of monthly blood sample collection of the previous 3 months, values >4% were considered high. A MIS>5 indicated nutritional risk. Results: We analyzed 2044 pts, 1148 (56%) males, 642 (31%) diabetic, with a mean age 68.4±14.12 years, a mean HD vintage 105±74 months and mean EPORI 7.23±7.51 (U/week/kg)/(g/dL). During a follow-up of 48 months, 719 pts (35%) died and 1291 pts (63%) were hospitalized at least once after baseline assessment, 531 pts and 400 pts were excluded because follow up was not possible and EPORI data was not available, respectively. ROC curve analysis identified different cut-off values for EPORI in relation with all-cause mortality and hospitalizations. Univariable analysis: An EPORI>5 was associated with higher MIS (7.06±3.9, vs 6.02±3.48, p<0.001), higher IDWG (3.15±1.23 vs 1.26±1.09, p<0.001), lower Hematocrit (Htc) (33.26±3.17 vs 33.69±2.61, p<0.001), higher C-Reactive Protein (CRP) 14.94±24.45 vs 10.4±18.9, p<0.001), female gender (57% vs 48%, p<0.001), death (58% vs 49%, p<0.001) and hospitalization (55% vs 47%, p<0.001). When analyzing with Kaplan-Meier estimator using log-rank test to compare survival curves, mortality and hospitalizations were increased in all sub-groups with higher values for EPORI (cut-offs of 5 to 8) when compared, respectively, with lower EPORI values. Multivariable analysis: The predictors of EPORI were MIS>5 (OR 1.564, p<0.001), IDWG (OR 1.234, p< 0.001), CRP (OR 1.010, p<0.001) and Htc (OR 0.948, p<0.001). In similar models, adjusting for MIS>5 (p<0.001), gender (p<0.001), age (p<0.001), CRP (p<0.001) and dialysis vintage (p<0.001), different EPORI cut-off values were associated with higher risk of mortality and hospitalizations. Conclusion: In the modern hemodialysis era, higher EPORI cut-off values were associated with a progressive higher risk of mortality and of hospitalization. The modification of the EPORI predictors that are susceptible to improvement, such as the nutritional and inflammation status, may contribute for a better prognosis in this population.