Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis
Abstract Preservation of residual kidney function (RKF) is important in patients undergoing peritoneal dialysis (PD). We aimed to examine the association between anemia management and residual urine output using data from a nationwide survey of dialysis patients. After excluding patients with anuria...
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Nature Portfolio
2025-01-01
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| Online Access: | https://doi.org/10.1038/s41598-025-87456-z |
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| author | Takahiro Imaizumi Takeshi Hasegawa Takaaki Kosugi Hiroki Nishiwaki Masanori Abe Norio Hanafusa Hirokazu Honda Kazuhiko Tsuruya Yasuhiko Ito Takahiro Kuragano |
| author_facet | Takahiro Imaizumi Takeshi Hasegawa Takaaki Kosugi Hiroki Nishiwaki Masanori Abe Norio Hanafusa Hirokazu Honda Kazuhiko Tsuruya Yasuhiko Ito Takahiro Kuragano |
| author_sort | Takahiro Imaizumi |
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| description | Abstract Preservation of residual kidney function (RKF) is important in patients undergoing peritoneal dialysis (PD). We aimed to examine the association between anemia management and residual urine output using data from a nationwide survey of dialysis patients. After excluding patients with anuria at baseline from the Total cohort of 2,712, 659 of 1,640 patients developed anuria during a median follow-up of 2.5 (interquartile range: 1.5–4.2) years. Urine volume decreased more rapidly as hemoglobin decreased or as the erythropoiesis-stimulating agent (ESA) resistance index (ERI) increased. The hazard ratios with 95% confidence intervals for the development of anuria, defined as residual urine volume ≤ 100 mL/day, were 1.65 (1.20–2.27), 1.39 (1.08–1.77), and 1.32 (1.07–1.63) for hemoglobin levels of < 9.0, 9.0–9.9, and 10.0–10.9 g/dL compared with 11.0–11.9 g/dL, and 1.35 (1.10–1.66) and 1.41 (1.14–1.73) for the second and third tertiles of ERI compared with the first tertile. In conclusion, patients with a low hemoglobin level or a high ERI were more likely to experience a decline in residual urine output and to develop anuria. Further studies are needed to investigate the effects of interventions that could improve renal anemia and/or ESA hyporesponsiveness on RKF preservation. |
| format | Article |
| id | doaj-art-e51dd9aaf19246f0bf4c8f12837ee902 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-e51dd9aaf19246f0bf4c8f12837ee9022025-01-26T12:26:28ZengNature PortfolioScientific Reports2045-23222025-01-0115111110.1038/s41598-025-87456-zRenal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysisTakahiro Imaizumi0Takeshi Hasegawa1Takaaki Kosugi2Hiroki Nishiwaki3Masanori Abe4Norio Hanafusa5Hirokazu Honda6Kazuhiko Tsuruya7Yasuhiko Ito8Takahiro Kuragano9Department of Advanced Medicine, Nagoya University HospitalInstitute of Clinical Epidemiology, Showa UniversityDepartment of Nephrology, Nara Medical UniversityDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of MedicineCommittee of the Japanese Society for Dialysis Therapy Renal Data Registry, the Japanese Society for Dialysis TherapyDivision of Nephrology, Department of Medicine, School of Medicine, Showa UniversityDepartment of Nephrology, Nara Medical UniversityDepartment of Nephrology and Rheumatology, Aichi Medical UniversityDivision of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of MedicineAbstract Preservation of residual kidney function (RKF) is important in patients undergoing peritoneal dialysis (PD). We aimed to examine the association between anemia management and residual urine output using data from a nationwide survey of dialysis patients. After excluding patients with anuria at baseline from the Total cohort of 2,712, 659 of 1,640 patients developed anuria during a median follow-up of 2.5 (interquartile range: 1.5–4.2) years. Urine volume decreased more rapidly as hemoglobin decreased or as the erythropoiesis-stimulating agent (ESA) resistance index (ERI) increased. The hazard ratios with 95% confidence intervals for the development of anuria, defined as residual urine volume ≤ 100 mL/day, were 1.65 (1.20–2.27), 1.39 (1.08–1.77), and 1.32 (1.07–1.63) for hemoglobin levels of < 9.0, 9.0–9.9, and 10.0–10.9 g/dL compared with 11.0–11.9 g/dL, and 1.35 (1.10–1.66) and 1.41 (1.14–1.73) for the second and third tertiles of ERI compared with the first tertile. In conclusion, patients with a low hemoglobin level or a high ERI were more likely to experience a decline in residual urine output and to develop anuria. Further studies are needed to investigate the effects of interventions that could improve renal anemia and/or ESA hyporesponsiveness on RKF preservation.https://doi.org/10.1038/s41598-025-87456-zAnuriaErythropoiesis-stimulating agent resistance indexHyporesponsiveness to erythropoiesis-stimulating agentPeritoneal dialysisResidual kidney function |
| spellingShingle | Takahiro Imaizumi Takeshi Hasegawa Takaaki Kosugi Hiroki Nishiwaki Masanori Abe Norio Hanafusa Hirokazu Honda Kazuhiko Tsuruya Yasuhiko Ito Takahiro Kuragano Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis Scientific Reports Anuria Erythropoiesis-stimulating agent resistance index Hyporesponsiveness to erythropoiesis-stimulating agent Peritoneal dialysis Residual kidney function |
| title | Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis |
| title_full | Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis |
| title_fullStr | Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis |
| title_full_unstemmed | Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis |
| title_short | Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis |
| title_sort | renal anemia and hyporesponsiveness to esa for preservation of residual kidney function in patients undergoing peritoneal dialysis |
| topic | Anuria Erythropoiesis-stimulating agent resistance index Hyporesponsiveness to erythropoiesis-stimulating agent Peritoneal dialysis Residual kidney function |
| url | https://doi.org/10.1038/s41598-025-87456-z |
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