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Titolo	Anaemia and resistance to erythropoiesis-stimulating agents as prognostic factors in haemodialysis patients: results from the RISCAVID study
Autore	Vincenzo Panichi1, Alberto Rosati2, Roberto Bigazzi3, Sabrina Paoletti1, Emanuela Mantuano3, Sara Beati1, Valentina Marchetti4, Giada Bernabini1, Giovanni Grazi5, Giovanni Manca Rizza5, Massimiliano Migliori1, Riccardo Giusti2, Alberto Lippi6, Aldo Casani7, Giuliano Barsotti4, and Ciro Tetta8 on behalf of the RISCAVID Study Group* - 1Nephrology and Dialysis Versilia Hospital, Versilia, Italy, 2Nephrology and Dialysis, Lucca, Italy, 3Nephrology and Dialysis, Livorno, Italy, 4Nephrology and Dialysis, University of Pisa, Pisa, Italy, 5Nephrology and Dialysis, USL5, Pontedera, Italy, 6Nephrology and Dialysis, Pisa, Italy, 7Nephrology and Dialysis, Massa, Italy and 8Western Europe Medical and Scientific Coordination, Fresenius Medical Care, Bad Homburg, Germany
Referenza	Nephrol Dial Transplant 2011; doi: 10.1093/ndt/gfq802
Contenuto	Background. Resistance to erythropoiesis-stimulating agents (ESAs) is often associated with chronic inflammation. Here, we investigated how anaemia, ESA resistance and the plasma levels of biological markers of inflammation could influence all-cause and cardiovascular disease morbidity and mortality. Methods. Seven hundred and fifty-three haemodialysis (HD) patients (mean age 66 6 14.2 years, mean dialytic age 70677 months and diabetes 18.8%) were enrolled and followed-up for 36 months. Demographic, clinical and laboratory data, co-morbidity conditions, administered drugs, all-cause mortality and fatal/non-fatal cardiovascular (CV) events were recorded. We measured ESA resistance index, C-reactive protein (CRP) and interleukin-6 (IL-6). Results. Six hundred and fifty-one patients (86.4%) received ESAs. Patients with haemoglobin level <11 g/dL (n ¼ 225) showed increased risk of CV [relative risk (RR) 1.415, 95% confidence interval (CI) 1.046-1.914] and overall mortality (RR 1.897, 95% CI 1.423-2.530) versus patients with haemoglobin levels >11 g/dL. ESA resistance values categorized into quartiles (Quartile I <5.6, Quartile II 5.7-9.6, Quartile III 9.7-15.4 and Quartile IV >15.4) correlated with all-cause mortality and fatal/ non-fatal CV events (RR 1.97, 95% CI 1.392-2.786; RR 1.619, 95% CI 1.123-2.332, respectively). Furthermore, albumin was significantly reduced versus reference patients and correlated with all-cause mortality and CV events; CRP levels were higher in hyporesponders (Quartile IV) (P < 0.001) and predicted all-cause mortality and CV events. IL-6 but not CRP was a strong predictor of ESA resistance. Conclusions. ESA responsiveness can be considered a strong prognostic factor in HD patients and seems to be tightly related to protein-energy wasting and inflammation.
Data	18.02.2011

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