Body mass index and resistance to recombinant human erythropoietin therapy in maintenance hemodialysis patients

Maria do Sameiro-Faria, Sandra Ribeiro, Petronila Rocha-Pereira, João Fernandes, Flávio Reis, Elsa Bronze-Da-Rocha, Vasco Miranda, Alexandre Quintanilha, Elísio Costa, Luís Belo, Alice Santos-Silva*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


The aim of this work was to contribute to a better understanding of the relationship between resistance to recombinant human erythropoietin (rhEPO) therapy and body mass index (BMI) in hemodialysis (HD) patients. We evaluated 191 HD patients and 25 healthy individuals. Complete blood count, reticulocyte count, and circulating levels of ferritin, transferrin, iron, soluble transferrin receptor (sTfR), transferrin saturation, hepcidin, C-reactive protein (CRP), interleukin 6 (IL-6), albumin, and adiponectin were measured in all patients and controls. Non-responder patients (n=16), as compared with responder patients (n=175), showed statistically significant lower BMI values, an enhanced inflammatory and higher adiponectin levels, associated with disturbances in iron metabolism. Analyzing the results according to BMI, we found that underweight patients required higher rhEPO doses than normal, overweight, and obese patients, and a higher percentage of non-responders patients were found within the underweight group of HD patients. Moreover, underweight patients presented lower levels of transferrin and higher levels of adiponectin compared to overweight and obese patients, and lower levels of iron compared with normal weight patients. Multiple regression analysis identified the sTfR, hemoglobin, BMI, and albumin as independent variables associated with rhEPO doses. In conclusion, our work showed that HD patients resistant to rhEPO therapy present a functional iron deficiency and a higher degree of inflammation, despite their lower BMI values and higher levels of adiponectin. Actually, BMI is poorly related with markers of systemic inflammation, such as IL-6 and CRP, while adiponectin works a fairly good indirect marker of adiposity within HD patients.
Original languageEnglish
Pages (from-to)1392-1398
Number of pages7
JournalRenal Failure
Issue number10
Publication statusPublished - Nov 2013
Externally publishedYes


  • Anemia
  • BMI
  • Body mass index
  • EPO
  • Erythropoietin
  • Hemodialysis
  • Inflammation
  • Resistance to rhEPO


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