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Effect of erythropoietin-stimulating agent on uremic inflammation
Yuri Tanaka1, Nobuhiko Joki, Hiroki Hase
1Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6, Ohashi, Tokyo, Meguro-ku, 153-8515, Japan. jokinobuhiko@gmail.com.
Insights
Erythropoietin-stimulating agents (ESA) may reduce inflammation in chronic kidney disease (CKD) patients. Further research is needed to confirm this effect on uremic inflammation.
Area of Science:
- Nephrology
- Clinical Medicine
- Pharmacology
Background:
- Uremic state in chronic kidney disease (CKD) is associated with inflammation.
- Medications commonly prescribed for CKD patients may influence the uremic state.
Purpose of the Study:
- To explore the effect of commonly prescribed medications on the uremic state in CKD patients.
- To investigate the association between serum C-reactive protein (CRP) and clinical factors, laboratory data, and medications in predialysis CKD patients.
Main Methods:
- Cross-sectional study of 900 end-stage kidney disease (ESKD) patients commencing hemodialysis (HD).
- Exclusion criteria included elevated CRP, abnormal white blood cell (WBC) count, and specific comorbidities.
- Explored associations between pre-dialysis CRP and clinical/laboratory data, including medication use.
Main Results:
- Serum CRP was correlated with age, CTR, eGFR, and WBC.
- Factors inversely associated with CRP included blood pressure, albumin, LDL-C, HDL-C, Hb, Cr, and Ca.
- Use of erythropoietin-stimulating agents (ESA), renin-angiotensin-aldosterone system inhibitors, and calcium channel blockers showed negative correlations with CRP; only ESA remained significant in multiple regression analysis.
Conclusions:
- Erythropoietin-stimulating agents (ESA) may significantly reduce uremic inflammation.
- ESA's potential anti-inflammatory effect in CKD warrants further investigation.
- A large-scale longitudinal study is required to confirm the anti-inflammatory role of ESA in CKD.
Background:
The goal of the present study was to explore the effect of medications that are commonly prescribed for CKD patients on uremic state.
Methods:
This was a cross-sectional study. From January 2006 to October 2009, 1,623 patients with end-stage kidney disease (ESKD) commenced hemodialysis (HD) at the 9 participating hospitals. The criteria for exclusion from the database were 1) serum C-reactive protein (CRP) > 3 mg/dL, 2) WBC count > 9,000/mm3 or <4,000/mm3, and 3) patients with cancer, immune complex disease, or vasculitis. A total of 900 patients were entered into the final database. We explored the association of serum CRP just before the first HD session with clinical characteristics, laboratory data, and medications for CKD in the predialysis period.
Results:
On univariate analysis, age, CTR, eGFR, and WBC were significantly correlated with CRP. Systolic and diastolic blood pressure, serum albumin, LDL-C, HDL-C, Hb, Cr, and Ca were inversely associated with CRP. Use of erythropoietin-stimulating agents (ESA) using (r = -0.111, p = 0.0015), renin-angiotensin-aldosterone system inhibitors (r = -0.083, p = 0.0154), and calcium channel blockers (r = -0.1, p = 0.0039) was also negatively correlated with CRP. However, only use of ESA showed a significant negative correlation with CRP that was independent of other clinical factors and CKD medications on multiple regression analysis.
Conclusion:
ESA may strongly reduce uremic inflammation in addition to improving anemia. To confirm this potential effect, a large-scale longitudinal study would be required.
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