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Titolo	Impact of elevated C-reactive protein levels on erythropoiesisstimulating agent (ESA) dose and responsiveness in hemodialysis patients
Autore	Brian D. Bradbury1, Cathy W. Critchlow1, Matthew R. Weir2, Ron Stewart1, Mahesh Krishnan3 and Raymond H. Hakim4 1Department of Biostatistics and Epidemiology, Amgen Inc., Thousand Oaks, CA, 2Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD, 3Global Health Economics, Amgen Inc., Thousand Oaks, CA and 4Fresenius Medical Care North America, Nashville, TN, USA
Referenza	Nephrol Dial Transplant 2009; 24 (3): 919-925
Contenuto	Background. Inflammation in an ESRD patient may impact responsiveness to erythropoiesis-stimulating agent (ESA) therapy. We sought to investigate the association between C-reactive protein (CRP) levels and average peradministration epoetin alfa (EPO) dose over 3 months following a CRP measurement. Methods. The study is a retrospective cohort study of hemodialysis patients ≥18 years of age receiving care at a Fresenius Medical Care-North America facility between 1 July 2000 and 30 June 2002 who had no history of peritoneal dialysis. All patients had ≥1 CRP measurement and ≥3 months of recorded information before the CRP measurement (entry period). We evaluated the association between CRP levels and average hemoglobin (Hb) and peradministration EPO dose over the 3 months following the CRP measurement. Results. We identified 1754 patients with a CRP measurement; mean age was 62.6 years (SD 14.1), 51.5% were male, 56.2% were white and the median CRP value was 2.04 mg/dL (20.4 mg/L). Patients in the upper CRP quartiles were more likely to be older, recently hospitalized; have a catheter vascular access; have lower albumin, Hb and transferrin saturation levels and greater EPO doses. In the subsequent 3 months, EPO doses but not Hb levels were significantly higher for patients in the highest CRP quartile [3.21 mg/dL (32.1 mg/L)] (P = 0.01). Conclusions. Inflammation as measured by an elevated CRP level appears to be an independent predictor of greater ESA dose requirements. Patients with the highest CRP levels required significantly higher ESA doses to achieve comparable Hb levels even after controlling for potential confounding variables.
Data	14.04.2009

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