A possible contributor to erythropoiesis-stimulating agents requirement in hemodialysis: Paraoxonase 1 activity

Abstract

Background: Anemia is one of the most prevalent complications of chronic kidney disease (CKD). In CKD-related anemia, circulating erythrocytes have a decreased life span. Paraoxonase-1 (PON1) activity is one of the essential factors protecting cell membranes, e.g., erythrocytes, from lipid peroxidation under normal conditions. In this study, we investigated PON1 activity in hemodialysis (HD) patients with and without erythropoiesis-stimulating agents (ESA) therapy and the possible relationship of PON1 activity levels with the ESA dose required. Methods: This study is composed of patients undergoing HD with a minimum dialysis vintage of six months. We excluded cases with an active infection, cardiovascular events and malignancy, hypo- or hyperthyroidism, central venous catheters, iron deficiency, cystic kidney diseases, nephrectomy, and routine C-reactive protein (CRP) levels higher than reference range within the last six months. Results: Baseline characteristics, laboratory parameters, oxidative stress, and systemic inflammatory indices were similar between groups. The mean PON1 activity of the ESA+ group was significantly lower than the ESA– group (191.4 ±118.8 and 488.1±174.9,respectively; p<0.001). Cumulative ESA doses and PON1 activity were significantly and negatively correlated (R=-0.736, p<0.001). Conclusion: The results of this study suggest that lower PON1 activity in HD patients is associated with the requirement for ESA therapy, presumably due to decreased life span of erythrocytes. Further studies examining the relationship between PON1 activity and ESA treatment requirements are necessary to reveal new treatment goals for CKD-related anemia.

Keywords

• Paraoxanase 1
• erythropoiesis-stimulating agents
• hemodialysis
• anemia

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