Relationship between anti-erythropoietin receptor autoantibodies and responsiveness to erythropoiesis-stimulating agents in patients on hemodialysis: a multi-center cross-sectional study

Background A decreased response to erythropoiesis-stimulating agents (ESAs) leads to refractory anemia and worse prognosis in patients with chronic kidney disease. We examined the association between autoantibodies to the erythropoietin receptor (EPOR) and responsiveness to ESAs in patients on maint...

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Published in:Clinical and experimental nephrology 2020-01, Vol.24 (1), p.88-95
Main Authors: Hara, Akinori, Koshino, Yoshitaka, Kurokawa, Yukie, Shinozaki, Yasuyuki, Miyake, Taito, Kitajima, Shinji, Toyama, Tadashi, Iwata, Yasunori, Sakai, Norihiko, Shimizu, Miho, Furuichi, Kengo, Nakamura, Hiroyuki, Wada, Takashi
Format: Article
Language:English
Subjects:
Autoantibodies
Body mass index
C-reactive protein
Cross-sectional studies
Enzyme-linked immunosorbent assay
Erythropoiesis
Erythropoietin
Ferritin
Hemodialysis
Hemoglobin
Immunoglobulins
Kidney diseases
Magnesium
Medicine
Medicine & Public Health
Multivariate analysis
Nephrology
Original Article
Refractory anemia
Risk factors
Urology
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Summary:Background A decreased response to erythropoiesis-stimulating agents (ESAs) leads to refractory anemia and worse prognosis in patients with chronic kidney disease. We examined the association between autoantibodies to the erythropoietin receptor (EPOR) and responsiveness to ESAs in patients on maintenance hemodialysis. Methods A total of 108 Japanese patients on maintenance hemodialysis at three institutions were enrolled. Sera from these patients were screened for anti-EPOR antibodies using an enzyme-linked immunosorbent assay. An ESA resistance index (ERI) was calculated, and patients in the highest ERI quartile were defined as ESA hyporesponsive. Results Anti-EPOR antibodies were detected in 11 patients (10%). Body mass index and hemoglobin, platelet, magnesium, and ferritin levels decreased with higher ERI levels. On the other hand, C-reactive protein (CRP) levels and the prevalence of anti-EPOR antibodies increased with higher ERI levels. In multivariate analysis, the presence of anti-EPOR antibodies together with CRP was a significant risk factor for ESA hyporesponsiveness. Conclusions Anti-EPOR antibodies were detected in patients on maintenance hemodialysis, and these autoantibodies were independent factors for hyporesponsiveness to ESAs in these patients.
ISSN:1342-1751
1437-7799
DOI:10.1007/s10157-019-01787-6