Observational studyBMC nephrology2015
Characterization of chronic and acute ESA hyporesponse: a retrospective cohort study of hemodialysis patients.
Observational study in BMC nephrology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 49 citations in OpenAlex.
- Roxadustat for the Maintenance Treatment of Anemia in Patients with End-Stage Kidney Disease on Stable Dialysis: A European Phase 3, Randomized, Open-Label, Active-Controlled Study (PYRENEES).Advances in therapy · 2021Trial
- KDIGO 2026 Clinical Practice Guideline for Anemia in Chronic Kidney Disease (CKD): a commentary from the European Renal Best Practice (ERBP).Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026Article
- Observational
- Navigating Anemia Therapy in CKD With Hypoxia-Inducible Factor Activators: A Review.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2026Review
- Anemia Treatment and Its Clinical Implications in Patients Receiving Hemodialysis Hyporesponsive to Erythropoietin-Stimulating Agents.Kidney medicine · 2026Article
- Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Dialysis-Dependent Patients with Anaemia of Chronic Kidney Disease: A Retrospective Observational Study.Advances in therapy · 2025Observational
- Hypoxia-inducible factor activators: a novel class of oral drugs for the treatment of anemia of chronic kidney disease.Hematology. American Society of Hematology. Education Program · 2024Review
- Safety and tolerability of the protein C activator AB002 in end-stage renal disease patients on hemodialysis: a randomized phase 2 trial.Communications medicine · 2024Article
- Residual Kidney Function in Hemodialysis: Its Importance and Contribution to Improved Patient Outcomes.Toxins · 2024Review
- Prolyl hydroxylase inhibitor desidustat improves anemia in erythropoietin hyporesponsive state.Current research in pharmacology and drug discovery · 2022Article
- Resistance to Erythropoiesis-Stimulating Agents among Patients on Hemodialysis Is Typically Transient.American journal of nephrology · 2022Article
- Challenging patient phenotypes in the management of anaemia of chronic kidney disease.International journal of clinical practice · 2021Review
- Treatment of Anemia in Kidney Disease: Beyond Erythropoietin.Kidney international reports · 2021Review
- Treatment of anemia in difficult-to-manage patients with chronic kidney disease.Kidney international supplements · 2021Article
- Article
- Association between carnitine deficiency and the erythropoietin resistance index in patients undergoing peritoneal dialysis: a cross-sectional observational study.Renal failure · 2020Observational
- Red cell transfusion in chronic kidney disease in the United States in the current era of erythropoiesis stimulating agents.Journal of nephrology · 2020Review
- Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach.Nutrients · 2020Review
- Erythropoietin Resistance in Patients with Chronic Kidney Disease: Current Perspectives.International journal of nephrology and renovascular disease · 2020Review
- Novel options for failing allograft in kidney transplanted patients to avoid or defer dialysis therapy.Current opinion in nephrology and hypertension · 2020Review
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSome patients with chronic kidney disease do not respond adequately to erythropoiesis-stimulating agent (ESA) treatment; these patients are referred to as ESA hyporesponders. There is no widely accepted contemporary definition for chronic ESA hyporesponse. The study objective was to propose and validate an operational definition for chronic ESA hyporesponse.
methodsThis was a retrospective cohort study using electronic health care records. Participants were anemic hemodialysis patients treated during February 2012 and were followed for 15 months. Patients' ESA response (responders) or lack of response (chronic and acute hyporesponders) based on longitudinal patterns of ESA dose and hemoglobin level was assessed. Persistence of hyporesponse, longitudinal iron measures, transfusion rates, and mortality rates were analyzed. Frequency of blood transfusions (monthly) and death rates (quarterly) were calculated. Log normalized serum ferritin concentration was analyzed.
resultsOf 97,677 eligible patients, 6632 had acute hyporesponsiveness (ESA responsiveness restituted in ≤ 4 months) and 3086 had chronic hyporesponsiveness (lack of ESA response for > 4 months). Over months 1-4 among chronic hyporesponders, mean serum ferritin (722-785 ng/mL) and transferrin saturation (TSAT; 26.76 %-27.08 %) were constant, while acute hyporesponsive patients experienced increased ferritin (654-760 ng/mL) and TSAT (25.71-30.88 %) levels. Compared to ESA responders (0.19-0.30 %), chronic hyporesponders were transfused 7-times (1.20-2.17 %) more frequently over follow-up. Quarterly mortality was greatest in chronic ESA hyporesponders (2.98-5.48 %), followed by acute ESA hyporesponders (2.17-3.30 %) and ESA responders (1.43-2.49 %). With consistence over the study, chronic hyporesponders died more frequently than patients in the other study cohorts.
conclusionsFindings indicate that 4 months of continuous ESA hyporesponsiveness can be used to differentiate acute from chronic hyporesponsiveness. This definition of chronic hyporesponsiveness is supported by outcome data showing higher mortality and transfusion rates in chronic hyporesponders compared to acute hyporesponders.
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