Sánchez Redrobán, José
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Sánchez Redrobán, José
Main Affiliation
Quito
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Scopus Author ID
59772297900

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Risk Factors Associated with Hyporesponsiveness to Erythropoietin in Chronic Kidney Disease Patients on Hemodialysis Who Present Anemia: A Multicenter Case-Control Study

2025 , Carlos Perez Tulcanaza , André Benítez-Baldassari , Andrea Banegas-Sarmiento , Sánchez Redrobán, José

Background: Anemia represents a significant complication in patients with advanced chronic kidney disease (CKD) on hemodialysis, primarily caused by reduced renal erythropoietin production. Despite erythropoiesis-stimulating agents (ESAs) being the cornerstone of treatment, hyporesponsiveness to these agents remains a clinical challenge with implications for patient outcomes. Objective: To identify and quantify risk factors associated with hyporesponsiveness to erythropoietin in patients with CKD on hemodialysis who present with anemia. Methods: This multicenter case–control study analyzed data from 784 hemodialysis patients receiving erythropoietin therapy across six dialysis centers in Ecuador between January and December 2019. Hyporesponsiveness was defined as requiring ≥ 200 IU/kg/week of erythropoietin alfa for ≥3 consecutive months to maintain target hemoglobin levels (10–12 g/dL). Demographic, clinical, and laboratory parameters were compared between hyporesponsive cases (n = 123) and responsive controls (n = 661). Bivariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results: The prevalence of erythropoietin hyporesponsiveness was 15.69%. A multivariate analysis identified female sex (adjusted OR = 1.96; 95% CI: 1.20–3.20; p < 0.001), age < 50 years (adjusted OR = 4.25; 95% CI: 2.42–7.47; p < 0.001), serum albumin < 4.0 g/dL (adjusted OR = 10.53; 95% CI: 6.53–16.98; p < 0.001), ferritin ≥ 800 ng/mL (adjusted OR = 7.28; 95% CI: 4.22–12.57; p < 0.001), transferrin saturation < 20% (adjusted OR = 9.27; 95% CI: 5.47–15.69; p < 0.001), parathyroid hormone ≥ 500 pg/mL (adjusted OR = 1.89; 95% CI: 1.16–3.09; p = 0.011), and use of renin–angiotensin system blockers (adjusted OR = 2.25; 95% CI: 1.36–3.71; p = 0.002) as independent risk factors for erythropoietin hyporesponsiveness. Conclusions: Multiple demographic, clinical, and laboratory factors independently contribute to erythropoietin hyporesponsiveness in hemodialysis patients. Identification of these risk factors may guide clinicians in developing individualized treatment approaches, optimizing erythropoietin dosing, and implementing targeted interventions to improve anemia management in this vulnerable population.

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HIV Disease hospitalizations and factors associated with in‐hospital mortality in Ecuador: A nationwide analysis from 2015 to 2023

2025 , German Josuet Lapo‐Talledo , Ángel Luis Zamora Cevallos , Carlos Rafael Arteaga Reyes , Sánchez Redrobán, José , Jhon Ernesto Delgado Pinargote , Ángela María Espinoza Guevara , Edgar Antonio Menéndez Cuadros

Human immunodeficiency virus (HIV) remains a significant public health concern worldwide, contributing to notable rates of hospitalization and mortality. This study aimed to analyse HIV disease hospitalization trends and factors associated with in‐hospital mortality in Ecuador during 2015–2023.MethodsOfficial national hospital discharge data were used. Hospitalization and in‐hospital mortality rates were calculated. Multivariable logistic regression was performed to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to identify factors associated with in‐hospital mortality.ResultsTotally 28 408 HIV disease hospitalizations were analysed; the majority were males 61.19% (n = 17 383). Average hospitalization rate was 18.48 per 100 000 inhabitants. In‐hospital deaths accounted for 11.31% (n = 3214). Older age (≥40 years) was significantly associated with a higher likelihood of death, particularly in 60–69 years (aOR 1.78, 95% CI 1.49–2.13) and ≥70 years (aOR 1.79, 95% CI 1.36–2.34). Patients with HIV‐related Pneumocystis jirovecii pneumonia (aOR 2.74, 95% CI 2.28–3.29) and multiple malignant neoplasms (aOR 4.30, 95% CI 1.66–11.15) had the highest mortality likelihood. Although a declining trend in mortality rates was observed throughout 2015–2023, there was an increase in mortality probabilities in 2021 which may be linked to healthcare disruptions during the COVID‐19 pandemic, while subsequent decline in 2022 and 2023 suggests improvements in HIV care access.ConclusionsWhile HIV‐related hospitalizations and mortality have declined in Ecuador, older patients and those with severe opportunistic infections or malignancies remain at higher risk. These findings underscore the need for early diagnosis, enhanced management of HIV‐related complications and sustained antiretroviral therapy (ART) coverage, particularly during public health crises.

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