Investigation of the Relationship between Lean Muscle Mass and Erythropoietin Resistance in Maintenance Haemodialysis Patients: A Cross-Sectional Study

Wen-Fang Chiang, Po-Jen Hsiao, Kun-Lin Wu, Hung-Ming Chen, Chi-Ming Chu and Jenq-Shyong Chan
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Wen-Fang Chiang: Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan 325, Taiwan
Po-Jen Hsiao: Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan 325, Taiwan
Kun-Lin Wu: Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan 325, Taiwan
Hung-Ming Chen: Division of Haematology and Oncology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan 325, Taiwan
Chi-Ming Chu: Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan
Jenq-Shyong Chan: Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan 325, Taiwan

IJERPH, 2022, vol. 19, issue 9, 1-12

Abstract: Each patient undergoing maintenance haemodialysis (MHD) has a different response to erythropoiesis-stimulating agents (ESAs). Haemodilution due to fluid overload has been shown to contribute to anaemia. Body mass index (BMI) has been shown to influence ESA response in dialysis patients; however, BMI calculation does not distinguish between fat and lean tissue. The association between lean muscle mass and erythropoietin hyporesponsiveness is still not well-known among MHD patients. We designed a cross-sectional study and used bioimpedance spectroscopy (BIS) to analyse the relationship between body composition, haemoglobin level, and erythropoietin resistance index (ERI) in MHD patients. Seventy-seven patients were enrolled in the study group. Compared with patients with haemoglobin ≥ 10 g/dL, those with haemoglobin < 10 g/dL had higher serum ferritin levels, malnutrition–inflammation scores (MIS), relative overhydration, ESA doses, and ERIs. In multivariate logistic regression, higher ferritin levels and MIS were the only predictors of lower haemoglobin levels. The ERI was significantly positively correlated with age, Kt/V, ferritin levels, and MIS and negatively correlated with albumin levels, BMI, and lean tissue index (LTI). Multivariate linear regression analysis revealed that ferritin levels, BMI, and LTI were the most important predictors of ERI. In MHD patients, using BIS to measure body composition can facilitate the development of early interventions that aim to prevent sarcopenia, support ESA responsiveness, and, consequently, improve anaemia management.

Keywords: anaemia; bioimpedance spectroscopy; erythropoietin resistance; haemodialysis; haemoglobin; lean muscle mass; sarcopenia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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