Resistencia a eritropoyetina y supervivencia en pacientes con enfermedad renal crónica 4-5 no-D y enfermedad cardíaca / Erythropoietin resistance and survival in non-dialysis patients with stage 4-5 chronic kidney disease and heart disease

Antecedentes: Los pacientes con enfermedad renal crónica (ERC) tienen con frecuencia patología cardíaca asociada. La coincidencia de ambos procesos puede potenciar la inflamación, aumentando los requerimientos de eritropoyetina (EPO) y empeorando la supervivencia. Objetivos: Conocer la prevalencia de patología cardíaca, su influencia en la dosis de EPO y la de ambos factores sobre la mortalidad en pacientes con ERC 4-5 no-D (no diálisis). Métodos: 134 pacientes (68% con EPO al inicio y el 72,3% a lo largo del seguimiento) seguidos durante 36 meses. Para evaluar la respuesta a la EPO se utilizó su índice de resistencia a la eritropoyetina (IRE): dosis de EPO semanal/peso/hemoglobina (Hb); el IRE se estimó basalmente y durante el período de los seis meses precedentes a la finalización del estudio. Resultados: 39 pacientes (29,1%), antecedentes de cardiopatía; 22 (16,4%), episodios de insuficiencia cardíaca (IC). El IRE fue superior en los pacientes con antecedentes de cardiopatía, con IC y en los tratados con inhibidores de la enzima convertidora de angiotensina/antagonistas de los receptores de angiotensina II; en el análisis multivariante (IRE como variable dependiente) compusieron el modelo final: ferritina, Hb, función renal y episodios de IC. Durante el período de seguimiento, 39 pacientes fallecieron. La supervivencia (Kaplan-Meier) a los 36 meses fue inferior en los pacientes con un IRE superior a la mediana (2,6 UI semana/kg/g de Hb en 100 ml) (p = 0,002), los que habían sufrido episodios de IC (p = 0,001) y los que tenían antecedentes de cardiopatía (p < 0,001). Conclusiones: Los pacientes con antecedentes cardiológicos en general y de IC en particular tienen un IRE aumentado. Tanto la presencia de estos antecedentes como un mayor IRE se asocian a la disminución de la supervivencia, pudiendo considerarse el IRE como marcador de riesgo de muerte a corto-medio plazo (AU)

Introduction: Patients with chronic kidney disease (CKD) frequently suffer from heart disease as well. The combination of the two processes can exacerbate inflammation, resulting in increases in both resistance to erythropoietin (EPO) and mortality. Objectives: The aim of this study was to determine the prevalence of heart disease in a representative group of non-dialysis patients with stage 4-5 CKD, and the influence of that entity on EPO requirements and on mortality during a period of 36 months. Methods: 134 patients (68% on EPO at the beginning, increasing to 72.3% during follow-up) were monitored for 36 months. To evaluate the dose-response effect of EPO therapy, we used the erythropoietin resistance index (ERI) calculated as the weekly weight-adjusted dose of EPO divided by the haemoglobin level. The ERI was determined both initially and during the last six months before the end of the study. Results: 39 patients (29.1%) had history of heart disease; 22 (16.4%) had suffered from heart failure (HF). The ERI was higher in patients with a history of heart disease or HF and those treated with drugs acting on the renin-angiotensin system (ACE inhibitors or ARBs). Using ERI as the dependent variable in the multivariate analysis, the variables that composed the final model were ferritin, haemoglobin, glomerular filtration rate and history of HF. The 36 month mortality rate (n=39 patients) was higher in the group having ERI above the median (2.6IU/week/kg/gram of haemoglobin in 100ml) (P=.002), and in the groups with heart disease (P=.001) or HF (P=.001) according to the Kaplan-Meier survival analysis. Conclusions: Patients with history of heart disease or HF have a higher ERI, and all of these characteristics are associated with lower survival. ERI can be considered a marker for risk of death in the short to-medium term (AU)

Erythropoietin resistance and survival in non-dialysis patients with stage 4-5 chronic kidney disease and heart disease.

INTRODUCTION: Patients with chronic kidney disease (CKD) frequently suffer from heart disease as well. The combination of the two processes can exacerbate inflammation, resulting in increases in both resistance to erythropoietin (EPO) and mortality. OBJECTIVES: The aim of this study was to determine the prevalence of heart disease in a representative group of non-dialysis patients with stage 4-5 CKD, and the influence of that entity on EPO requirements and on mortality during a period of 36 months. METHODS: 134 patients (68% on EPO at the beginning, increasing to 72.3% during follow-up) were monitored for 36 months. To evaluate the dose-response effect of EPO therapy, we used the erythropoietin resistance index (ERI) calculated as the weekly weight-adjusted dose of EPO divided by the haemoglobin level. The ERI was determined both initially and during the last six months before the end of the study. RESULTS: 39 patients (29.1%) had history of heart disease; 22 (16.4%) had suffered from heart failure (HF). The ERI was higher in patients with a history of heart disease or HF and those treated with drugs acting on the renin-angiotensin system (ACE inhibitors or ARBs). Using ERI as the dependent variable in the multivariate analysis, the variables that composed the final model were ferritin, haemoglobin, glomerular filtration rate and history of HF. The 36 month mortality rate (n=39 patients) was higher in the group having ERI above the median (2.6IU/week/kg/gram of haemoglobin in 100ml) (P=.002), and in the groups with heart disease (P=.001) or HF (P=.001) according to the Kaplan-Meier survival analysis. CONCLUSIONS: Patients with history of heart disease or HF have a higher ERI, and all of these characteristics are associated with lower survival. ERI can be considered a marker for risk of death in the short to-medium term.