Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients

Nephrol Dial Transplant. 2006 Apr;21(4):991-8. doi: 10.1093/ndt/gfk011. Epub 2005 Dec 29.


Background: Chronic kidney disease patients who are resistant to erythropoietin (EPO) treatment may suffer from malnutrition and/or inflammation.

Methods: In a cross-sectional study of haemodialysis patients, we investigated the relationship between the natural logarithm of the weekly EPO dose normalized for post-dialysis body weight and outcome measures of nutrition and/or inflammation [BMI, albumin and C reactive protein (CRP)] by means of multiple linear regression analysis. On the basis of the decile distribution of weekly EPO doses, we also evaluated four groups of patients: untreated, hyper-responders, normo-responders and hypo-responders.

Results: Six hundred and seventy-seven adult haemodialysis patients were recruited from five Italian centres. BMI and albumin were lower in the hypo-responders than in the other groups (21.3+/-3.8 vs 24.4+/-4.7 kg/m(2), P<0.001; and 3.8+/-0.6 vs 4.1+/-0.4 g/dl, P<0.001), whereas the median CRP level was higher (1.9 vs 0.8 mg/dl, P = 0.004). The median weekly EPO dose ranged from 30 IU/kg/week in the hyper-responsive group to 263 IU/kg/week in the hypo-responsive group. Transferrin saturation linearly decreased from the hyper- to hypo-responsive group (37+/-15 to 25+/-10%, P = 0.003), without any differences in transferrin levels. Ferritin levels were lower in the hypo-responsive than in the other patients (median 318 vs 445 ng/ml, P = 0.01). At multiple linear regression analysis, haemoglobin, BMI, albumin, CRP and serum iron levels were independently associated with the natural logarithm of the weekly EPO dose (R(2) = 0.22).

Conclusions: Our findings support a clear association between EPO responsiveness and nutritional and inflammation variables in haemodialysis patients; iron deficiency is still a major cause of hypo-responsiveness.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Body Weight
  • C-Reactive Protein / metabolism
  • Cross-Sectional Studies
  • Erythropoietin / therapeutic use*
  • Female
  • Humans
  • Inflammation*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Nutritional Status*
  • Renal Dialysis*


  • Erythropoietin
  • C-Reactive Protein