Abstract: Objective  To analyze the relationship between blood vitamin D levels, neutrophil-to-lymphocyte ratio (NLR), and erythropoietin (EPO) hypo-responsiveness in patients undergoing maintenance hemodialysis (MHD).  Methods  The clinical data of 160 patients who underwent MHD in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine were reviewed.  The efficacy of blood vitamin D and NLR in predicting EPO hypo-responsiveness and their dose-response relationship were evaluated.  Results  Compared with the non-EPO hypo-responsive group, the EPO hypo-responsive group had significantly lower 25(OH)D (t =7.671, P<0.001) and hemoglobin levels (t=8.601, P<0.001), and significantly longer dialysis vintage, higher weekly recombinant human erythropoietin (rhuEPO) dosage, higher parathyroid hormone, C-reactive protein (CRP), and NLR levels (t=2.153, P=0.033; t=12.685, P<0.001; t=3.330, P=0.001; t=3.004, P= 0.003; t=4.148, P<0.001). Logistic regression analysis showed that dialysis vintage, NLR, and parathyroid hormone were risk factors for EPO hypo-responsiveness (OR=1.813, 95% CI： 1.354～2.272; OR=2.724, 95% CI ：2.379～3.068; OR=1.416, 95% CI ：1.001～2.246; all P<0.001), while 25(OH)D was a protective factor (OR =0.413, 95% CI：0.404～2.379, P<0.001). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the combined prediction of 25(OH)D and NLR was 0.920, indicating higher predictive efficacy (95% CI ：0.859～0.960, P = 0.005). A nonlinear dose-response relationship was observed between 25(OH)D, NLR, and EPO hypo-responsiveness.  Conclusion  The combination of 25(OH)D and NLR demonstrates high predictive efficacy for EPO hypo-responsiveness, and a dose-response relationship exists between them.

Key words: Maintenance hemodialysis, Blood vitamin D, Neutrophil/lymphocyte ratio, Erythropoietin, Hypo-responsiveness