de Lurdes Agostinho Cabrita et al identified risk factors for a high ratio of erythropoietin-stimulating agent dose to hemoglobin ratio. The authors are from Hospital de Faro in Algarve, Portugal.
Patient selection: chronic kidney disease stage 4 or 5, pre-dialysis
Measure: ratio of erythropoiesis-stimulating agent (ESA) dose to hemoglobin, which is a measure of ESA resistance
Risk factors for a high ESA to hemoglobin ratio in a logistic regression analysis:
(1) female gender (odds ratio 4.9)
(2) malnutrition
(3) cardiovascular disease (odds ratio 4.4)
(4) inflammation with elevated TNF-alpha and/or IL-6
where:
• A high ferritin and cytokines begs the question for anemia of chronic disease
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