Evaluation of Erythropoietin Stimulating Agent’s Responsiveness and Associated Factors in Hemodialysis Patients with Anemia

Abstract Background: Chronic kidney disease (CKD) patients often develop erythropoietin-deficient anemia. Erythropoietin stimulating agents (ESAs) are the conventional treatment for CKD anemia, but patient responses vary. About 10%–15% of erythropoietin-treated patients may not respond, thus identifying hyporesponsiveness causes may help overcome resistance. Objective: This study is designed to evaluate ESA therapy’s responsiveness and to identify possible contributing factors for ESA resistance. Materials and Methods: This observational cross-sectional study was conducted between September 2022 and February 2023 comprised 150 CKD and patients with anemia in a multicenter dialysis unit. Demographic, clinical, and laboratory data were obtained. The weekly body-weight-adjusted ESA dose divided by hemoglobin concentration is calculated as the erythropoietin resistance index (ERI). ERI values of 5 (responsive), 5–15 (hyporesponsive), and >15 (resistant). Results: A total of 150 patients were enrolled among whom 86 (57.3%) were males with a mean age 51.6 ± 14.9 years. Regarding responses of the patients to ESA, 81 patients (54%) were hyporesponsive, 66 patients (44%) were resistanct and 3 patients (2%) were responsive. There was a significant difference in response according to age, body mass index (BMI), and the presence of co-existing diseases among study groups. Phosphate level was directly associated with the presence of resistance. ERI was positively correlated with dialysis frequency, ESA dose, serum iron, and transferrin saturation. Conclusion: According to the findings of this study, many factors can influence response levels in patients with CKD undergoing hemodialysis based on ERI (age, BMI, presence of co-existing diseases, serum phosphorus, serum iron, and transferrin saturation).