Inflammation, high ferritin, and erythropoietin resistance in indigenous maintenance hemodialysis patients from the T op E nd of N orthern A ustralia

Use of erythropoiesis‐stimulating agents ( ESAs ) has improved the management of anemia in patients on maintenance hemodialysis ( MHD ). Iron deficiency and inflammation cause ESAs resistance and are both common among indigenous people of N orthern A ustralia. As part of quality assurance in our R enal A naemia M anagement program, we observed that there was use of higher doses of ESAs and adjuvant iron therapy in our MHD patients. This study aimed to explore the relationship among iron studies, inflammation, ESA responsiveness, and ESAs and iron requirements in indigenous patients on MHD from the T op E nd of N orthern A ustralia. We performed a retrospective cohort analysis of anemia management in a cohort of our patients on MHD . We extracted data for 178 indigenous and 19 non‐indigenous patients from 1 M arch 2009 to 28 F ebruary 2010 from the R enal A naemia M anagement database, which collects data prospectively in MHD patients. Ninety‐nine percent of the whole sample had a ferritin level above the international guidelines threshold of >500 µg/L. Indigenous patients had higher ferritin (1534 ± 245.5 µg/L vs. 1013 ± 323.3 µg/L, P = 0.002). C‐reactive protein ( CRP ) was high in 56.9% of the total cohort. One hundred percent of those with normal CRP had high ferritin (>500 µg/L). C‐reactive protein was higher in indigenous than in non‐indigenous patients. Erythropoiesis‐stimulating agents hyporesponsiveness was higher in indigenous patients (P