Elevated Anti-Cytomegalovirus IgG Levels Are Associated with Higher Erythropoiesis-Stimulating Agent Dose in Transplant-Listed Patients with End-Stage Kidney Disease
- 1Department of Nephrology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
- 2Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- 3Sferogen, 5270 Ajdovscina, Slovenia
Abstract
Background. CMV seropositivity has been associated with increased epoetin demand in patients with end-stage kidney disease (ESKD) undergoing kidney replacement therapy (KRT). However, the available data remain inconclusive. Methods. In this single-center retrospective study we screened adult kidney transplant candidates with dialysis-dependent ESKD and whose CMV serostatus was known. Baseline patient characteristics and erythropoiesis-stimulating agent (ESA) prescription data were evaluated. Multivariate analysis was performed to determine whether CMV seropositivity or anti-CMV immunoglobulin levels are associated with more frequent ESA prescription and higher standardized ESA weekly dose. Results. A total of 198 patients were included, with a median age of 51 years; 31% were female. The majority of patients (73%) were treated with hemodialysis, and the median dialysis vintage was 1 year. ESA therapy was prescribed to 77% of patients, with a standardized median weekly dose of 61 units per kilogram of body weight. CMV seropositivity was identified in 79% of patients and was associated with older age, longer dialysis vintage, higher serum CRP and ferritin levels, and lower serum total iron-binding capacity. In adjusted regression models, ESA prescription rate and ESA weekly dose were not associated with CMV seropositivity. Conversely, higher ESA weekly dose was associated with CMV IgG levels in the 5th quintile (both p < 0.001) after adjustment for hemoglobin levels and body iron stores. Conclusion. CMV seropositivity was not associated with an increased likelihood of ESA prescription among transplant-listed individuals with ESKD. In a fully adjusted regression model, however, standardized weekly ESA dose was significantly higher in individuals with anti-CMV IgG levels in the highest quintile. Further studies are warranted to determine the true nature of these observations. If confirmed, it will be important to clarify whether elevated anti-CMV IgG levels reflect underlying immune dysregulation, or conversely, whether CMV reactivations contribute both to increased IgG levels and to ESA hyporesponsiveness.
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BibTeX
@article{jerman2026elevated,
title = {{Elevated Anti-Cytomegalovirus IgG Levels Are Associated with Higher Erythropoiesis-Stimulating Agent Dose in Transplant-Listed Patients with End-Stage Kidney Disease}},
author = {Alexander Jerman and Miha Arnol and Vanja Peršič},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218541},
url = {https://www.mdpi.com/2077-0383/15/21/8541},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Elevated Anti-Cytomegalovirus IgG Levels Are Associated with Higher Erythropoiesis-Stimulating Agent Dose in Transplant-Listed Patients with End-Stage Kidney Disease
AU - Alexander Jerman
AU - Miha Arnol
AU - Vanja Peršič
PY - 2026
DA - 2026/11/02
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218541
UR - https://www.mdpi.com/2077-0383/15/21/8541
AB - Background. CMV seropositivity has been associated with increased epoetin demand in patients with end-stage kidney disease (ESKD) undergoing kidney replacement therapy (KRT). However, the available data remain inconclusive. Methods. In this single-center retrospective study we screened adult kidney transplant candidates with dialysis-dependent ESKD and whose CMV serostatus was known. Baseline patient characteristics and erythropoiesis-stimulating agent (ESA) prescription data were evaluated. Multivariate analysis was performed to determine whether CMV seropositivity or anti-CMV immunoglobulin levels are associated with more frequent ESA prescription and higher standardized ESA weekly dose. Results. A total of 198 patients were included, with a median age of 51 years; 31% were female. The majority of patients (73%) were treated with hemodialysis, and the median dialysis vintage was 1 year. ESA therapy was prescribed to 77% of patients, with a standardized median weekly dose of 61 units per kilogram of body weight. CMV seropositivity was identified in 79% of patients and was associated with older age, longer dialysis vintage, higher serum CRP and ferritin levels, and lower serum total iron-binding capacity. In adjusted regression models, ESA prescription rate and ESA weekly dose were not associated with CMV seropositivity. Conversely, higher ESA weekly dose was associated with CMV IgG levels in the 5th quintile (both p < 0.001) after adjustment for hemoglobin levels and body iron stores. Conclusion. CMV seropositivity was not associated with an increased likelihood of ESA prescription among transplant-listed individuals with ESKD. In a fully adjusted regression model, however, standardized weekly ESA dose was significantly higher in individuals with anti-CMV IgG levels in the highest quintile. Further studies are warranted to determine the true nature of these observations. If confirmed, it will be important to clarify whether elevated anti-CMV IgG levels reflect underlying immune dysregulation, or conversely, whether CMV reactivations contribute both to increased IgG levels and to ESA hyporesponsiveness.
SN - 2077-0383
ER -