Long Dialysis Time is the More Important Factor of Erythropoietin Response in Hemodialysis Patients with Diabetes than Kt/V

Background: Though inadequate dialysis is a known risk factor for resistance to erythropoietin (EPO) therapy, there is no consensus about the relationship between hemodialysis (HD) time and EPO requirement. Our study sought to explore the relationship between EPO dosage and dialysis time in HD patients with diabetes. Methods: We report a cross-sectional analysis of the relationship between EPO dosage and dialysis time in HD patients with diabetes. A total of 77 patients with diabetes receiving maintenance HD at three outpatient HD facilities in Japan were included. At one such facility, HD time was 6 hours (n=37), and at the other facilities, HD time was 4 hours (n=40). In 6-hour HD patients and 4-hour HD patients, we studied parameters of weekly EPO requirement, Kt/V, hemoglobin, ferritin, albumin, C-reactive protein and intact parathyroid hormone. These parameters were analyzed with JMP9TM statistical software (SAS Institute). Results: Means for hemoglobin, ferritin, albumin, C-reactive protein and intact parathyroid hormone were not significantly different between the 6-hour and 4-hour HD patient groups. The EPO requirement was significantly lower among 6-hour HD patients (3111.8 ± 2360.8 versus 5682.9 ± 3863.3 U/week. P=0.0007). Kt/V was not significantly different between the two groups. Multiple regression analysis with EPO requirement as the dependent variable showed that dialysis time was the only significant independent variable (P=0.0001). Conclusions: Six-hour HD without a significant increase in dialysis dose, as judged by Kt/V, can reduce the dose of EPO in HD patients with diabetes.