Statin use is associated with lower inflammation and erythropoietin responsiveness index in hemodialysis patients Mehmet KOC, 1 Cengiz DOGAN, 2 Turgay ARINSOY, 2 Zeki TONBUL, 2 Deniz AYLI, 2 Mustafa CIRIT, 2 Mehmet Sukru SEVER, 2 Mehmet Emin YILMAZ, 2 Abdulkadir UNSAL, 2 Gultekin SULEYMANLAR, 2 Ercan OK, 2 Ali BASCI, 2 Alaatin YILDIZ 2,3 1 Department of Internal Medicine, Division of Nephrology, Marmara University School of Medicine, Istanbul University, Istanbul, Turkey; 2 Fresenius Medical Care-Turkey, Istanbul, Turkey; 3 Department of Internal Medicine, Division of Nephrology, Istanbul School for Medicine, Istanbul University, Istanbul, Turkey Abstract Patients with end-stage renal disease are prone to inflammation and inflammation is related to erythropoietin-stimulating agent hyporesponsiveness and mortality in this population. Statins have been demonstrated to reduce cardiovascular mortality in selected populations of end-stage renal disease patients. These drugs have pleiotrophic effects such as anti-inflammation. In this retrospec- tive analysis, we determined whether the use of statins improves inflammation and inflammation- related anemia in a cohort of hemodialysis patients. Data were analyzed from Fresenius Medical Care Dialysis Clinics in Turkey between 2005 and 2007. Seventy prevalent hemodialysis patients who were on statins at the start of the study and have been on statins during follow-up (statin users) and 1293 patients who were not on statin at the start of the study and had never been prescribed any lipid-modifying drugs during follow-up (statin nonusers) were included in the study. High-sensitive C-reactive protein levels were significantly decreased in statin users (1.50  1.49 vs. 1.33  1.11 mg/L, P = 0.05) compared with nonusers (1.93  3.22 vs. 2.05  2.77 mg/L). Hemoglo- bin levels and the rate of erythropoietin-stimulating agent users were similar. However, the pre- scribed erythropoietin-stimulating agent dose (31.6  27.5 vs. 47.3  45.2 U/kg/week, Po0.05) and the erythropoietin response index (2.90  2.73 vs. 4.51  4.48 U/kg/week/Hb, P = 0.001) were lower in statin users compared with statin nonusers. On stepwise multiple regression analysis, gen- der, high-sensitive C-reactive protein, duration of hemodialysis, serum ferritin, and statin use were independent determinants of the erythropoietin responsiveness index. Our results suggest that sta- tin treatment leads to lower inflammation and improves hematopoiesis in hemodialysis patients. Key words: erythropoietin resistance, anemia, hsCRP, inflammation, statin, hemodialysis INTRODUCTION Cardiovascular disease (CVD) is the leading cause of mor- bidity and mortality in hemodialysis (HD) patients and cardiovascular (CV) mortality is approximately 30 times higher than that in the general population. 1 Traditional as Correspondence to: A. Yildiz, MD, Department of Internal Medicine, Division of Nephrology, Istanbul School of Medicine, Istanbul University, Capa, Topkapi, Istanbul 34390 Turkey. E-mail: alayildiz@yahoo.com Hemodialysis International 2011; 15:366–373 r 2011 The Authors Hemodialysis International r 2011 International Society for Hemodialysis DOI:101111/j.1542-4758.2011.00547.x 366