PowerPoint Slides for: Erythropoietin Hyporesponsiveness in Dialysis Patients: Possible Role of Statins

Background: Hypothesizing that statins may be useful as
adjuvant treatment for renal anemia, we examined the association
between statin prescription (Rx) and erythropoiesis-stimulating agent
(ESA) hyporesponsiveness in Japanese hemodialysis (HD) patients
prescribed ESAs. Methods: We examined 3,602 patients in 60
HD facilities dialyzed 3 times/week for ≥4 months from the Japan
Dialysis Outcomes and Practice Patterns Study phases 3-5 (2005-2015).
Statin Rx was reported at the end of a 4-month interval (baseline) for
each patient. ESA hyporesponsiveness in the subsequent 4 months was then
defined as a binary indicator (mean hemoglobin [Hgb] level <10 g/dL
and mean ESA dose >6,000 units/week) and separately as the ESA
resistance index (ERI; mean ESA dose/[dry weight × mean Hgb]). We used
adjusted logistic and linear regressions to evaluate the associations
between statin Rx and ESA hyporesponsiveness. Results: At
baseline, 16.2% of patients reported statin Rx; 12.8% were classified as
having ESA hyporesponsiveness during 4 months of follow-up. Compared to
patients without statin Rx, patients with statin Rx had lower odds of
ESA hyporesponsiveness (OR 0.87; 95% CI 0.66-1.15). Similarly, the ERI
was lower for those with statin Rx than without (ratio of means, 0.94;
95% CI 0.89-0.99) after adjustment for possible confounders. Conclusions:
Our results suggest that statins may slightly reduce ESA
hyporesponsiveness in HD patients. However, any causal inference is
limited by the observational study design and unmeasured compliance with
statin Rx.