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The following is a summary of “Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis,” published in the January 2025 issue of Nephrology by Imaizumi et al. 

Researchers conducted a prospective study to examine the impact of anemia management on residual urine output in patients with peritoneal dialysis (PD). Lower hemoglobin and higher erythropoiesis-stimulating agent (ESA) resistance were linked to faster urine output decline and higher anuria risk. 

They analyzed data from a nationwide survey of 2,712 dialysis patients, excluding those with baseline anuria. A cohort of 1,640 patients was followed for a median of 2.5 years (interquartile range (IQR): 1.5–4.2). Hemoglobin levels and erythropoiesis-stimulating agent (ESA) resistance index (ERI) were assessed for their impact on anuria development (residual urine volume ≤100 mL/day), with hazard ratios (HR) and 95% CI calculated for different hemoglobin levels and ERI tertiles. 

The results showed that 659 of 1,640 patients developed anuria. Urine volume declined faster with lower hemoglobin or higher ERI. HR for anuria was 1.65 (1.20–2.27), 1.39 (1.08–1.77), and 1.32 (1.07–1.63) for hemoglobin levels <9.0, 9.0–9.9, and 10.0–10.9 g/dL, respectively, compared with 11.0–11.9 g/dL. For ERI, HR was 1.35 (1.10–1.66) and 1.41 (1.14–1.73) for the second and third tertiles compared with the first. 

Investigators concluded that lower hemoglobin levels and higher ERI increased the risk of residual urine output decline and anuria. Further studies were needed to assess interventions for improving renal anemia and ESA hypo responsiveness to preserve residual kidney function (RKF). 

Source: nature.com/articles/s41598-025-87456-z