Publication date: Feb 24, 2025
Background/Objectives: Hemodialysis (HD) patients with advanced chronic kidney disease (CKD) are highly vulnerable to complications from SARS-CoV-2 infection. Anemia management in this population is complex, particularly due to erythropoietin resistance, which may be exacerbated by COVID-19-related inflammation. To this aim, in this small-scale retrospective study, we investigated trends in the erythropoietin resistance index (ERI) over time in patients with and without SARS-CoV-2 infection. Methods: This single-center retrospective study included 25 HD patients, divided into two groups: 15 with a history of SARS-CoV-2 infection (CoV2 group) and 10 without (nonCoV2 group). The ERI was assessed over four visits, with 70-100-day intervals between them. Linear mixed models were used to evaluate factors associated with ERI changes. Results: Patients in the CoV2 group exhibited significantly higher ERI increases between T1 (baseline) and T2 (post-infection) compared to the nonCoV2 group (median ΔERI: +4. 65 vs. -0. 27, p < 0. 001). During the T2-T4 recovery period, CoV2 patients demonstrated a delayed but substantial decline in the ERI, converging to baseline levels by T4. Male sex and hemoglobin levels were negatively associated with the ERI. Conclusions: SARS-CoV-2 infection induces transient but significant erythropoietin resistance in HD patients, likely due to inflammation and disrupted erythropoiesis. Tailored anemia management strategies, including the potential use of hypoxia-inducible factor stabilizers, are warranted. Larger, multicenter studies are needed to validate these findings and improve treatment protocols.
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| Concepts | Keywords |
|---|---|
| Hemodialysis | anemia |
| Hypoxia | chronic kidney disease |
| Kidney | COVID-19 |
| erythropoietin | |
| hemodialysis | |
| kidney failure | |
| renal replacement therapies | |
| Sars-CoV-2 |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | SARS-CoV-2 Infection |
| pathway | REACTOME | SARS-CoV-2 Infection |
| drug | DRUGBANK | Erythropoietin |
| disease | MESH | chronic kidney disease |
| disease | MESH | complications |
| disease | MESH | Anemia |
| disease | MESH | inflammation |
| disease | IDO | history |
| disease | MESH | infection |
| disease | MESH | hypoxia |
| drug | DRUGBANK | Coenzyme M |
| disease | MESH | kidney failure |
| disease | MESH | morbidity |
| disease | MESH | death |
| disease | MESH | uremia |
| disease | IDO | production |
| drug | DRUGBANK | Iron |
| disease | MESH | viral infection |
| disease | MESH | iron deficiency |
| disease | IDO | blood |
| disease | MESH | arteriovenous fistula |
| disease | MESH | anuria |
| disease | MESH | liver cancer |
| disease | MESH | aplasia |
| disease | MESH | bleeding |
| drug | DRUGBANK | Heparin |
| drug | DRUGBANK | Calcium |
| drug | DRUGBANK | Potassium |
| disease | MESH | hypertension |
| disease | MESH | cancer |
| disease | MESH | diabetes mellitus |
| disease | MESH | cerebrovascular disease |
| drug | DRUGBANK | Creatinine |
| drug | DRUGBANK | Timonacic |
| disease | MESH | Glomerulonephritis |
| disease | MESH | ADPKD |
| disease | MESH | end stage kidney disease |