Abstract
Background
A decreased response to erythropoiesis-stimulating agents (ESAs) leads to refractory anemia and worse prognosis in patients with chronic kidney disease. We examined the association between autoantibodies to the erythropoietin receptor (EPOR) and responsiveness to ESAs in patients on maintenance hemodialysis.
Methods
A total of 108 Japanese patients on maintenance hemodialysis at three institutions were enrolled. Sera from these patients were screened for anti-EPOR antibodies using an enzyme-linked immunosorbent assay. An ESA resistance index (ERI) was calculated, and patients in the highest ERI quartile were defined as ESA hyporesponsive.
Results
Anti-EPOR antibodies were detected in 11 patients (10%). Body mass index and hemoglobin, platelet, magnesium, and ferritin levels decreased with higher ERI levels. On the other hand, C-reactive protein (CRP) levels and the prevalence of anti-EPOR antibodies increased with higher ERI levels. In multivariate analysis, the presence of anti-EPOR antibodies together with CRP was a significant risk factor for ESA hyporesponsiveness.
Conclusions
Anti-EPOR antibodies were detected in patients on maintenance hemodialysis, and these autoantibodies were independent factors for hyporesponsiveness to ESAs in these patients.
Similar content being viewed by others
References
Macdougall IC, Cooper AC. Erythropoietin resistance: the role of inflammation and pro-inflammatory cytokines. Nephrol Dial Transplant. 2002;17:39–433.
Luo J, Jensen DE, Maroni BJ, Brunelli SM. Spectrum and burden of erythropoiesis-stimulating agent hyporesponsiveness among contemporary hemodialysis patients. Am J Kidney Dis. 2016;68:763–71.
Yamamoto H, Nishi S, Tomo T, Masakane I, Saito K, Nangaku M, et al. 2015 Japanese Society for dialysis therapy: guidelines for renal anemia in chronic kidney disease. Renal Replace Ther. 2017;3:36.
KDIGO. Chapter 3: use of ESAs and other agents to treat anemia in CKD. Kidney Int Suppl. 2012;2:299–310.
Hara A, Furuichi K, Higuchi M, Iwata Y, Sakai N, Kaneko S, et al. Autoantibodies to erythropoietin receptor in patients with immune-mediated diseases: relationship to anaemia with erythroid hypoplasia. Br J Haematol. 2013;160:244–50.
Koibuchi K, Miyagi M, Arai T, Aoki T, Aikawa A, Sakai K. Comparing the efficacy of continuous erythropoietin receptor activator and darbepoetin Alfa treatments in Japanese patients with chronic kidney disease during the predialysis period: a propensity-matched analysis. Nephrology. 2015;20:22–8.
Daugirdas JT. The post: pre-dialysis plasma urea nitrogen ratio to estimate K.t/V and NPCR: mathematical modeling. Int J Artif Organs. 1989;12:411–9.
Okamoto T, Hatakeyama S, Tanaka Y, Imanishi K, Takashima T, Saitoh F, et al. Butyrylcholinesterase level as an independent factor of erythropoiesis-stimulating agent resistance in patients on maintenance hemodialysis: a single-center cross-sectional study. Clin Exp Nephrol. 2018;22:1174–81.
Schwarzbeck A, Wittenmeier KW, Hällfritzsch U. Anaemia in dialysis patients as a side-effect of sartanes. Lancet. 1998;352:286.
Hara A, Furuichi K, Yamahana J, Yasuda H, Iwata Y, Sakai N, et al. Effect of autoantibodies to erythropoietin receptor in systemic lupus erythematosus with biopsy-proven lupus nephritis. J Rheumatol. 2016;43:1328–34.
Hara A, Furuichi K, Koshino A, Yasuda H, Tran T, Iwata Y, et al. Clinical and pathological significance of autoantibodies to erythropoietin receptor in type 2 diabetic patients with CKD. Kidney Int Rep. 2017;3:133–41.
Bradbury BD, Critchlow CW, Weir MR, Stewart R, Krishnan M, Hakim RH. Impact of elevated C-reactive protein levels on erythropoiesis- stimulating agent (ESA) dose and responsiveness in hemodialysis patients. Nephrol Dial Transplant. 2009;24:919–25.
Rattanasompattikul M, Molnar MZ, Zaritsky JJ, Hatamizadeh P, Jing J, Norris KC, et al. Association of malnutrition-inflammation complex and responsiveness to erythropoiesis-stimulating agents in long-term hemodialysis patients. Nephrol Dial Transplant. 2013;28:1936–45.
Chen Y, Abbate M, Tang L, Cai G, Gong Z, Wei R, et al. L-Carnitine supplementation for adults with end-stage kidney disease requiring maintenance hemodialysis: a systematic review and meta-analysis. Am J Clin Nutr. 2014;99:408–22.
Biesalski HK. Parenteral ascorbic acid in haemodialysis patients. Curr Opin Clin Nutr Metab Care. 2008;11:741–6.
Rusu A, Rusu F, Zalutchi D, Muresan A, Gherman Caprioara M, Kacso I. The influence of vitamin E supplementation on erythropoietin responsiveness in chronic hemodialysis patients with low levels of erythrocyte superoxide dismutase. Int Urol Nephrol. 2013;45:495–501.
Kobayashi H, Abe M, Okada K, Tei R, Maruyama N, Kikuchi F, et al. Oral zinc supplementation reduces the erythropoietin responsiveness index in patients on hemodialysis. Nutrients. 2015;7:3783–95.
Higuchi T, Matsukawa Y, Okada K, Oikawa O, Yamazaki T, Ohnishi Y, et al. Correction of copper deficiency improves erythropoietin unresponsiveness in hemodialysis patients with anemia. Intern Med. 2006;45:271–3.
Altura BM, Altura BT. Role of magnesium in patho-physiological processes and the clinical utility of magnesium ion selective electrodes. Scand J Clin Lab Investig Suppl. 1996;224:211–34.
Sakaguchi Y, Fujii N, Shoji T, Hayashi T, Rakugi H, Isaka Y. Hypomagnesemia is a significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis. Kidney Int. 2014;85:174–81.
Allegra A, Corica F, Ientile R, Naso A, Corsonello A, Montalto G, et al. Effect of intravenous recombinant erythropoietin administration on plasma and erythrocyte magnesium concentrations in patients on hemodialysis. Nephron. 1996;74:499–500.
Drüeke TB, Parfrey PS. Summary of the KDIGO guideline on anemia and comment: reading between the (guide)line(s). Kidney Int. 2012;82:952–60.
Acknowledgements
We thank Hiroka Yamazaki, Yoshiko Isaki, and Mayumi Fukuta for their assistance with data collection.
Funding
This work was supported by a grant from The Kidney Foundation, Japan (number JKFB17-3) and the Japan Society for the Promotion of Science Grants-in-Aid for Scientific Research (JSPS KAKENHI) Grant number JP16K09608.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors have declared no competing interest.
Ethical approval
All the procedures performed in studies involving human participants were in accordance with the ethical standards of the medical ethics committee of Kanazawa University at which the studies were conducted (approval number 1590) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Hara, A., Koshino, Y., Kurokawa, Y. et al. Relationship between anti-erythropoietin receptor autoantibodies and responsiveness to erythropoiesis-stimulating agents in patients on hemodialysis: a multi-center cross-sectional study. Clin Exp Nephrol 24, 88–95 (2020). https://doi.org/10.1007/s10157-019-01787-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-019-01787-6