The following is a summary of “Is metabolic-dysfunction-associated fatty liver disease or advanced liver fibrosis associated with erythropoietin stimulating agent hypo-responsiveness among patients with end-stage kidney disease on haemodialysis?,” published in the June 2023 issue of Nephrology by Wong et al.

Researchers performed a retrospective study to determine the association between metabolic-dysfunction-associated fatty liver disease (MAFLD) or advanced liver fibrosis (ALF) and ESA hypo-responsiveness in hemodialysis patients.

They conducted transient elastography using FibroTouch on 379 hemodialysis patients. Erythropoietin Resistance Index (ERI), categorizing patients with the highest ERI tertile as exhibiting ESA hypo-responsiveness, was utilized to assess ESA responsiveness.

The results showed the occurrence of MAFLD in patients with ESA hypo-responsiveness was lower than those without. ESA hypo-responsive exhibited notably elevated FIB-4 index. Factors such as female (aOR = 3.4, 95% CI = 1.9–6.2, P<0.001), dialysis duration ≥50 months (aOR = 1.8, 95% CI = 1.1–2.9, P<0.05), elevated waist circumference (aOR = 0.4, 95% CI = 0.2–0.8, P=0.005), low platelet count (aOR = 2.6, 95% CI 1.3–5.1, P<0.01), elevated total cholesterol (aOR = 0.5, 95% CI 0.3–0.9, P<0.05), and low serum iron (aOR = 3.8, 95% CI = 2.3–6.5, P<0.001) were independently associated with ESA hypo–responsiveness. No independent association was found between MAFLD or advanced liver fibrosis and ESA responsiveness. However, for each 1 kPA increase in LSM, the likelihood of ESA–hyporesponsiveness increased by 13% (aOR = 1.1, 95% CI = 1.0–1.2, P=0.002) when UAP and LSM were used instead of the presence of MAFLD and advanced liver fibrosis.

They concluded that MAFLD and advanced liver fibrosis were not independently associated with ESA hypo-responsiveness, but liver fibrosis may be a potential clinical marker.

Source: onlinelibrary.wiley.com/doi/10.1111/nep.14186