The etiology of ESA hyporesponsiveness is likely multifactorial, with contributions from inflammation, iron deficiency, hyperparathyroidism, and inadequate clearance from dialysis, among others.4,5 In the present analyses, the most potent associations for MACE outcomes in multivariable models were observed with age, history of CV disease, and lower serum albumin. Here, ALB is linked to hyperparathyroidism.