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Butyrylcholinesterase level as an independent factor of erythropoiesis-stimulating agent resistance in patients on maintenance hemodialysis: a single-center cross-sectional study

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Abstract

Background

Erythropoiesis-stimulating agent (ESA) responsiveness is related to the nutritional status of patients on hemodialysis (HD). Serum butyrylcholinesterase (BChE), an alpha-glycoprotein, may decrease in case of malnutrition. We investigated whether BChE was independently related to ESA resistance in patients on HD.

Methods

The laboratory data and ESA resistance index (ERI), defined as ESA dosage per week divided by dry weight and hemoglobin, were investigated in 215 patients on HD between July and September 2017. Malnutrition was defined as Geriatric Nutritional Risk Index (GNRI) of < 91.2. The patients were stratified into two groups: ERI-high (ERI ≥ 9.44) and ERI-low (ERI < 9.44) groups. Variables such as patient’s background, medication, and laboratory data were compared between the two groups. The optimal cutoff value of BChE for higher ERI was determined using receiver operating characteristic analysis. Factors independently associated with higher ERI were determined using multivariate logistic regression analysis.

Results

The median and optimal cutoff values of ERI and BChE were 6.51 and 200 IU/L, respectively. The study included 71 (33%) and 144 (67%) patients in the ERI-high and ERI-low groups, respectively. Significant between-group differences were observed concerning age, hemoglobin, ESA dose, lipid profiles, serum albumin, body mass index, GNRI, iron metabolism markers, ferric medicines, and BChE. Multivariate analysis showed that BChE < 200 IU/L (odds ratio 3.67; 95% confidence interval 1.73–7.77) continued to be an independent factor associated with higher ERI after adjusting for potential confounders, which was a similar odds ratio as GNRI < 91.2.

Conclusion

BChE may be an independent indicator of ESA resistance.

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Acknowledgements

We thank Sakiko Fujita, Akiko Kimura, Mieko Kawamura, Chizu Kawase, Kumiko Sato, and Masahiko Tezuka for their invaluable help with data collection. We would like to appreciate Enago (http://www.enago.jp) for English language support.

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Authors and Affiliations

  1. Department of Urology, Oyokyo Kidney Research Institute Aomori Hospital, 101-1 Okabe, Ishie, Aomori, 038-0003, Japan

    Teppei Okamoto, Yoshimi Tanaka, Kengo Imanishi, Tooru Takashima & Fumitada Saitoh

  2. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan

    Shingo Hatakeyama, Takuya Koie & Chikara Ohyama

  3. Department of Urology, Oyokyo Kidney Research Institute, 90, Yamazaki, Ozawa, Hirosaki, Japan

    Tadashi Suzuki

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  1. Teppei Okamoto
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  2. Shingo Hatakeyama
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  3. Yoshimi Tanaka
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  4. Kengo Imanishi
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Correspondence to Teppei Okamoto.

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Conflict of interest

The authors have declared that no conflict of interest exists.

Human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2017-089) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Registration of clinical trials

The trial is registered in the UMIN Clinical Trials Registry UMIN000028064.

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Informed consent was obtained from all individual participants included in the study.

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Okamoto, T., Hatakeyama, S., Tanaka, Y. et al. Butyrylcholinesterase level as an independent factor of erythropoiesis-stimulating agent resistance in patients on maintenance hemodialysis: a single-center cross-sectional study. Clin Exp Nephrol 22, 1174–1181 (2018). https://doi.org/10.1007/s10157-018-1569-z

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  • DOI: https://doi.org/10.1007/s10157-018-1569-z

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