Evidence map›Paper›PMID 26843352›Full record

ArticleHemodialysis international. International Symposium on Home Hemodialysis2016

The greatly misunderstood erythropoietin resistance index and the case for a new responsiveness measure.

Yossi Chait, Sahir Kalim, Joseph Horowitz, Christopher V Hollot, Elizabeth D Ankers, Michael J Germain, Ravi I Thadhani

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Article in Hemodialysis international. International Symposium on Home Hemodialysis, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.

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0cells of the map it votes in
23citing papers in PubMed, 1 pooled it
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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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3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  20. Obesity may be erythropoietin dose-saving in hemodialysis patients.Kidney research and clinical practice · 2018
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4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

7 authors.

Yossi ChaitDepartment of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, USA.
Sahir KalimDepartment of Medicine, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Joseph HorowitzDepartment of Mathematics and Statistics, University of Massachusetts, Amherst, MA, USA.
Christopher V HollotDepartment of Electrical and Computer Engineering, University of Massachusetts, Amherst, MA, USA.
Elizabeth D AnkersDepartment of Medicine, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Michael J GermainBaystate Medical Center, Springfield, and Tufts University School of Medicine, MA, USA.
Ravi I ThadhaniDepartment of Medicine, Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Funding

The effects of protein carbamylation in end stage kidney diseaseK23DK106479 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI KALIM, SAHIR · 2015 to 2019
$789k
The Engineering of Individualized Anemia Management ProtocolsK25DK096006 · NIDDK · UNIVERSITY OF MASSACHUSETTS AMHERST · PI CHAIT, YOSSI · 2013 to 2016
$670k
Patient Oriented Studies of Vitamin D in Chronic Kidney DiseaseK24DK094872 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI THADHANI, RAVI · 2012 to 2016
$546k
NIDDK NIH HHS K23 DK106479NIDDK NIH HHS K24 DK094872NIDDK NIH HHS K25 DK096006
6 · The paper itself

Abstract

Introduction The optimal use of erythropoiesis stimulating agents (ESAs) to treat anemia in end stage renal disease remains controversial due to reported associations with adverse events. In analyzing these associations, studies often utilize ESA resistance indices (ERIs), to characterize a patient's response to ESA. In this study, we examine whether ERI is an adequate measure of ESA resistance. Methods We used retrospective data from a nonconcurrent cohort study of incident hemodialysis patients in the United States (n = 9386). ERI is defined as average weekly erythropoietin (EPO) dose per kg body weight (wt) per average hemoglobin (Hgb), over a 3-month period (ERI = (EPO/wt)/Hgb). Linear regression was used to demonstrate the relationship between ERI and weight-adjusted EPO. The coefficient of variation was used to compare the variability of Hgb with that of weight-adjusted EPO to explain this relationship. This analysis was done for each quarter during the first year of dialysis. Findings ERI is strongly linearly related with weight-adjusted EPO dose in each of the four quarters by the equation ERI = 0.0899*(EPO/wt) (range of R(2)  = 0.97-0.98) and weakly linearly related to 1/Hgb (range of R(2)  = 0.06-0.16). These correlations hold independent of age, sex, hgb level, ERI level, and epo-naïve stratifications. Discussion ERI is strongly linearly related to weight-adjusted (and nonweight-adjusted) EPO dose by a "universal," not patient-specific formula, and thus is a surrogate of EPO dose. Therefore, associations between ERI and clinical outcomes are associations between a confounded EPO dose and those outcomes.

Indexed as

AnemiaErythropoietinFemaleHumansMaleMiddle AgedModels, TheoreticalRetrospective StudiesErythropoietinAnemiabiostatisticsmathematical models

Identifiers

PMID26843352
PMCPMC4934130

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.