ESA Hyporesponsiveness Linked to Worse Survival in Hemodialysis Patients, Regardless of Ferritin Levels

A study examining the relationship between erythropoiesis-stimulating agent (ESA) hyporesponsiveness, serum ferritin levels, and survival in hemodialysis patients has found that high ESA resistance index (ERI) is associated with poorer survival outcomes, independent of ferritin levels.

Data from the Japan Dialysis Outcomes and Practice Patterns Study Phases 4-6 (2009-2018) were analyzed, involving 5,154 patients.

The study assessed all-cause mortality and evaluated the effects of serum ferritin levels and ESA resistance on patient survival, with progressive adjustment for potential covariates.

Key findings include:

• During a median follow-up period of 2.6 years, 773 patients died.
• After adjusting for covariates, the mortality hazard ratio (HR) for low serum ferritin was 0.99 (95% CI: 0.81–1.20) and for high serum ferritin was 1.12 (95% CI: 0.89–1.41), indicating no significant mortality risk associated with ferritin levels.
• Elevated ERI was associated with an increased mortality risk (HR 1.44, 95% CI: 1.17–1.78), even after adjusting for confounders.
• The interaction between serum ferritin and ERI was not significant (p > 0.96).

The study concludes that ESA hyporesponsiveness, as indicated by a high ERI, is an independent predictor of worse survival in hemodialysis patients, emphasizing the need to address ESA resistance in this patient population to improve clinical outcomes.