Kivonat:
Background: Resistance to erythropoiesis-stimulating agents
(ESAs) has been observed in patients with chronic kidney disease
(CKD) and it is associated with clinical outcomes. The presence
of ESA resistance cannot always be explained by the known risk
factors of the condition, suggesting that additional factors may
be involved. We wanted to test the hypothesis that vitamin D
insufficiency is associated with lower hemoglobin (Hb) and ESA
resistance in patients on maintenance hemodialysis (HD).
Methods: Data from patients receiving maintenance HD in a
single dialysis center were extracted from the medical records
in a retrospective chart review. Basic patient characteristics
and laboratory data including Hb, serum albumin, intact
parathyroid hormone and serum 25(OH)-cholecalciferol
(25(OH)D(3)) levels were collected. ESA dose and Kt/V were
extracted from the dialysis charts. Correlation analysis and
multivariate linear regression analysis were used to reveal
potential independent associations between clinical and
laboratory parameters and ESA resistance. Results: Data from 142
patients were analyzed. Serum 25(OH)D(3) concentration was
significantly correlated with Hb (rho = 0.186, p < 0.05) and
also with ESA dose/Hb index (rho = 0.230, p < 0.01). In
multivariable regression analyses, serum 25(OH)D(3)
concentration remained significantly associated with both Hb and
ESA dose/Hb index after controlling for potentially important
confounders. Conclusion: Serum 25(OH)D(3) concentration is
independently associated with erythropoietin responsiveness in
CKD patients on maintenance HD. If this association will be
confirmed, treatment trials looking at the effect of vitamin D
supplementation on anemia treatment in CKD patients may be
warranted.
