Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients

Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients

Higher doses of erythropoiesis-stimulating agents (ESAs) contribute to atherothrombotic cardiovascular disease in hemodialysis (HD) patients. Thrombocytosis is associated with increased mortality in ESA-treated HD patients. We investigated variables affecting platelet count and its variability (plat...

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Main Authors: Koike, Kiyomi, Fukami, Kei, Kawaguchi, Atsushi, Shimamatsu, Kazumasa, Yamagishi, Sho-ichi, Okuda, Seiya
Format: Online
Language:English
Published: Dove Medical Press 2016
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822794/
id pubmed-4822794
recordtype oai_dc
spelling pubmed-48227942016-04-20 Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients Koike, Kiyomi Fukami, Kei Kawaguchi, Atsushi Shimamatsu, Kazumasa Yamagishi, Sho-ichi Okuda, Seiya Original Research Higher doses of erythropoiesis-stimulating agents (ESAs) contribute to atherothrombotic cardiovascular disease in hemodialysis (HD) patients. Thrombocytosis is associated with increased mortality in ESA-treated HD patients. We investigated variables affecting platelet count and its variability (platelet count increment [Δplatelet count]) in HD patients. This retrospective longitudinal and observational study of HD outpatients was carried out over 3 years. The outcome was independent determinants of platelet count and Δplatelet count, which were associated with iron indices, ESA dose, and C-reactive protein. In univariate regression analysis, V-shaped relationship was observed between platelet count and transferrin saturation (TSAT), ferritin, serum iron, and hemoglobin (Hb) with the bottom of 0.21, 330 ng/mL, 49 µg/dL, and 10.3 g/dL, respectively. Mixed-effect multivariate regression analysis revealed that TSAT (inversely), Hb ≤10.3 g/dL (inversely), C-reactive protein, and ESA dose were independently associated with platelet count. Δplatelet count was independently and inversely correlated with ΔTSAT and directly correlated with Δferritin. TSAT was independently and inversely associated with ESA dose. ESA dose was directly correlated with iron dose and inversely correlated with TSAT, ferritin ≤330 ng/mL, and Hb ≤10.3 g/dL. ESA dose and TSAT were correlated in determining platelet count and Δplatelet count. Targets of iron indices that reflect iron supply sufficient to avoid platelet count increment and variability may be >21% of TSAT and 300 ng/mL of serum ferritin for appropriate ESA therapy in HD patients. Dove Medical Press 2016-03-31 /pmc/articles/PMC4822794/ /pubmed/27099526 http://dx.doi.org/10.2147/IJNRD.S98196 Text en © 2016 Koike et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
repository_type Open Access Journal
institution_category Foreign Institution
institution US National Center for Biotechnology Information
building NCBI PubMed
collection Online Access
language English
format Online
author Koike, Kiyomi
Fukami, Kei
Kawaguchi, Atsushi
Shimamatsu, Kazumasa
Yamagishi, Sho-ichi
Okuda, Seiya
spellingShingle Koike, Kiyomi
Fukami, Kei
Kawaguchi, Atsushi
Shimamatsu, Kazumasa
Yamagishi, Sho-ichi
Okuda, Seiya
Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients
author_facet Koike, Kiyomi
Fukami, Kei
Kawaguchi, Atsushi
Shimamatsu, Kazumasa
Yamagishi, Sho-ichi
Okuda, Seiya
author_sort Koike, Kiyomi
title Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients
title_short Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients
title_full Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients
title_fullStr Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients
title_full_unstemmed Regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients
title_sort regulation of platelet count by erythropoiesis-stimulating agents – iron axis in hemodialysis patients
description Higher doses of erythropoiesis-stimulating agents (ESAs) contribute to atherothrombotic cardiovascular disease in hemodialysis (HD) patients. Thrombocytosis is associated with increased mortality in ESA-treated HD patients. We investigated variables affecting platelet count and its variability (platelet count increment [Δplatelet count]) in HD patients. This retrospective longitudinal and observational study of HD outpatients was carried out over 3 years. The outcome was independent determinants of platelet count and Δplatelet count, which were associated with iron indices, ESA dose, and C-reactive protein. In univariate regression analysis, V-shaped relationship was observed between platelet count and transferrin saturation (TSAT), ferritin, serum iron, and hemoglobin (Hb) with the bottom of 0.21, 330 ng/mL, 49 µg/dL, and 10.3 g/dL, respectively. Mixed-effect multivariate regression analysis revealed that TSAT (inversely), Hb ≤10.3 g/dL (inversely), C-reactive protein, and ESA dose were independently associated with platelet count. Δplatelet count was independently and inversely correlated with ΔTSAT and directly correlated with Δferritin. TSAT was independently and inversely associated with ESA dose. ESA dose was directly correlated with iron dose and inversely correlated with TSAT, ferritin ≤330 ng/mL, and Hb ≤10.3 g/dL. ESA dose and TSAT were correlated in determining platelet count and Δplatelet count. Targets of iron indices that reflect iron supply sufficient to avoid platelet count increment and variability may be >21% of TSAT and 300 ng/mL of serum ferritin for appropriate ESA therapy in HD patients.
publisher Dove Medical Press
publishDate 2016
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822794/
_version_ 1613563014496124928

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