EPO resistance is a strong independent predictor of mortality in chronic hemodialysis patients: a single- center retrospective cohort study

Abstract

Context and Objective. Anemia is a very common complication of chronic kidney failure. Its causes are multiple, notably erythropoietin (EPO) deficiency. The objectives of this study were to determine the prevalence of EPO resistance, identify associated factors, and assess their impact on mortality.Methods. This was a single-center retrospective cohort study including patients undergoing hemodialysis for at least three months and weekly treated with EPO. EPO resistance index (ERI) was defined according to KDIGO criteria as a requirement of ≥300 IU/kg/week of EPO. The Kaplan-Meier method was used to describe survival curves of patients. Multivariate logistic and Cox regression models were used to identify factors associated with ERI and predictors of mortality, respectively. Results. A total of 185 hemodialysis patient records (mean age: 70.7 ± 14 years, male sex: 62.4%) were analyzed. The mean hemoglobin level was 10.7 ± 0.8 g/dL, with normocytic values of 92.8 ± 6.4 fL. The cumulative incidence of ERI was 30.3%. Independent factors associated with ERI included hypoalbuminemia, while male gender was found to be protective. ERI 3, age ≥60 years, and hypoalbuminemia emerged as independent predictors of mortality, increasing the risk by factors of 2.1, 3.1, and 2.2, respectively (p < 0.05). Conclusion. EPO resistance is highly prevalent, particularly in cases of hypoalbuminemia, which negatively impacts the survival of chronic hemodialysis patients. Patients with ERI 3, female gender, and malnutrition require special attention. Received: February 6th, 2025Accepted: April 25th, 2025 https://dx.doi.org/10.4314/aamed.v18i3.2