Inflammation and Erythropoietin Resistance in Chronic Kidney Disease: A Cross-Sectional Study of C-Reactive Protein and Anemia in Hemodialysis Patients.

Background: Anemia represents a frequent complication in patients with chronic kidney disease (CKD) on hemodialysis. Inflammation results in disruption of erythropoiesis and establishment of less effective responses to erythropoiesis-stimulating agents (ESAs).

Objective: This study investigated how systemic inflammation, which C-reactive protein (CRP) measured, relates to anemia severity and erythropoietin (EPO) responsiveness among patients with chronic kidney disease who undergo maintenance hemodialysis.

Methods: Cross-sectional study design involving 120 CKD patients. Participants were classified into high inflammation group for CRP levels at or above 10 mg/L and low inflammation group for CRP levels below 10 mg/L. Hematological parameters and iron status indices were analyzed, and weekly EPO doses were recorded. Pearson correlation and multivariable linear regression analyses were done while controlling for age, sex, comorbidities, and dialysis duration.

Results: High inflammation group displayed hematocrit level of 29.6% ± 4.8% while the control group showed a level of 34.2% ± 5.2% which produced a statistically significant difference (p < 0.001). CRP exhibited a negative correlation with hematocrit (r = -0.42, p < 0.001) and transferrin saturation (r = -0.36, p < 0.001) but showed a positive correlation with EPO dose (r = 0.48, p < 0.001). CRP established an independent relationship with hematocrit (β = -0.43, 95% CI: -0.58 to -0.28) and EPO dosage (β = 401, 95% CI: 210 to 592) during the multivariable analysis.

Limitations: Cross-sectional design restricts causal relationships while the research team evaluated CRP as the only inflammatory marker.

Conclusions: Systemic inflammation establishes a significant connection to anemia severity and EPO resistance, which affects CKD patients.