Butyrylcholinesterase Level As an Independent Factor of Erythropoiesis-stimulating Agent Resistance in Patients on Maintenance Hemodialysis: a Single-center Cross-sectional Study

Overview

Journal Clin Exp Nephrol

Publisher Springer

Specialty Nephrology

Date 2018 Mar 31

PMID 29600410

Citations 3

Authors

Teppei Okamoto

Shingo Hatakeyama

Yoshimi Tanaka

Kengo Imanishi

Tooru Takashima

Fumitada Saitoh

Takuya Koie

Tadashi Suzuki

Chikara Ohyama

Affiliations

Soon will be listed here.

Abstract

Background: Erythropoiesis-stimulating agent (ESA) responsiveness is related to the nutritional status of patients on hemodialysis (HD). Serum butyrylcholinesterase (BChE), an alpha-glycoprotein, may decrease in case of malnutrition. We investigated whether BChE was independently related to ESA resistance in patients on HD.

Methods: The laboratory data and ESA resistance index (ERI), defined as ESA dosage per week divided by dry weight and hemoglobin, were investigated in 215 patients on HD between July and September 2017. Malnutrition was defined as Geriatric Nutritional Risk Index (GNRI) of < 91.2. The patients were stratified into two groups: ERI-high (ERI ≥ 9.44) and ERI-low (ERI < 9.44) groups. Variables such as patient's background, medication, and laboratory data were compared between the two groups. The optimal cutoff value of BChE for higher ERI was determined using receiver operating characteristic analysis. Factors independently associated with higher ERI were determined using multivariate logistic regression analysis.

Results: The median and optimal cutoff values of ERI and BChE were 6.51 and 200 IU/L, respectively. The study included 71 (33%) and 144 (67%) patients in the ERI-high and ERI-low groups, respectively. Significant between-group differences were observed concerning age, hemoglobin, ESA dose, lipid profiles, serum albumin, body mass index, GNRI, iron metabolism markers, ferric medicines, and BChE. Multivariate analysis showed that BChE < 200 IU/L (odds ratio 3.67; 95% confidence interval 1.73-7.77) continued to be an independent factor associated with higher ERI after adjusting for potential confounders, which was a similar odds ratio as GNRI < 91.2.

Conclusion: BChE may be an independent indicator of ESA resistance.

Citing Articles

The First-Known Case of Hereditary Heterozygous Butyrylcholinesterase Deficiency in a Patient on Dialysis.

Tokunaga N, Shima H, Okamoto T, Maekawa M, Minakuchi J Cureus. 2024; 16(1):e53153.

PMID: 38420074 PMC: 10900173. DOI: 10.7759/cureus.53153.

Relationship between anti-erythropoietin receptor autoantibodies and responsiveness to erythropoiesis-stimulating agents in patients on hemodialysis: a multi-center cross-sectional study.

Hara A, Koshino Y, Kurokawa Y, Shinozaki Y, Miyake T, Kitajima S Clin Exp Nephrol. 2019; 24(1):88-95.

PMID: 31502102 DOI: 10.1007/s10157-019-01787-6.

Low serum butyrylcholinesterase is independently related to low fetuin-A in patients on hemodialysis: a cross-sectional study.

Okamoto T, Tsutaya C, Hatakeyama S, Konishi S, Okita K, Tanaka Y Int Urol Nephrol. 2018; 50(9):1713-1720.

PMID: 30128921 DOI: 10.1007/s11255-018-1957-z.

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