Anaemia and its Response to Treatment with Recombinant Human Erythropoietin in Chronic Kidney Disease Patients

Abstract

BACKGROUND: The introduction of erythropoietin has transformed the management of anaemia in CKD, with considerable benefits which includes enhanced quality of life, increased exercise capacity and improved cardiac function. There is paucity of data on the beneficial effects of this treatment from this environment. OBJECTIVE: The aim of this work was to study the pattern and response of anaemia and its response to treatment with recombinant human erythropoietin(r-HuEpo) in CKD patients in Nigeria. METHODS: This was a prospective study in which 20 CKD patients who satisfied the inclusion criteria were recruited consecutively. Subcutaneous r-HuEpo was administered to each of the study patients, starting with a weekly dose of 50 iu/Kg and titrated according to haemoglobin (Hb) response, which was monitored fortnightly throughout the study period with the aim of achieving a target Hb of 11g/dl. RESULTS: The patients studied were anaemic with mean Hb of 7.36 ± 1.05 g/dl. The anemia was normocytic normochromic in 85% of the patients. All the patients responded to treatment with r-HuEpo with the mean Hb rising from 6.74g/dl ± 0.70 to 11.64g/dl ± 0.37 and 7.64 g/dl ± 1.19 to 11.98 g/dl ± 0.45 g/dl in those on maintenance haemodialysis and pre-dialysis patients respectively. The patients reached the target Hb of 11g/dl within 8 weeks in predialytic CKD patients and within 10 weeks in those on maintenance haemodialysis. CONCLUSION: Anaemia is mostly normocytic normochromic in CKD patients in our environment and r-HuEpo therapy is effective in correcting the anaemia. WAJM 2009; 28(5): 295-299.

Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting

“…The higher prevalence of anemia in our study was within the range of figures reported in similar groups of patients elsewhere 2,3,[13][14][15] . However, the predominantly microcytic and hypochromic patterns could be explained either by the inflammatory state associated with chronic infection or by the presence of context specific factors (not investigated) such as nutritional deficiencies, hemoglobinopathies and parasitic diseases 7,8 .…”

“…Our study also has some strengths in the sense that it provides a unique picture, which, in this setting can potentially contribute to raise more attention on anemia, a leading condition in people with CKD. It revealed the positive correlation between hematological profile and erythropoietin and IV iron therapy in a few patients receiving these therapies, even in non-optimal dose, due to financial constraints as reported in similar setting 14,15 . Our efforts in tracking a large number of our participants during follow-up provides some indicators of the burden of anemia in chronic hemodialysis patients and the outcome of anemia correction approaches in the context of limited access to ESA and intravenous iron therapies.…”

“…However, chronic hemodialyzed patients have chronic anemia due to the lack of erythropoietin production related to ESRD, achieving effective anemia correction in these patients in such settings by blood transfusion can be very challenging due to the scarcity of safe blood as already mentioned and the absence of a coordinated national blood transfusion service. In order to reduce the risk of blood transmitted diseases in our setting, improved access to ESA and IV iron should be the best way for correcting ESRD related anemia as recommended elsewhere 11,[13][14][15] . As of now, erythropoietin and IV iron accessibility is limited by the prohibitive cost which was about US$ 30 for 2000 IU of erythropoietin and US$ 25 for 100 mg of IV iron at the time this study was conducted.…”

Effectiveness of erythropoietin in correcting anemia in patients of chronic kidney disease.

“…Prevalence of anemia in CKD stage 1 is 31.2% and 93.3% in CKD stage 4 and 5. [6][7][8][9][10][11][12] Erythropoietin is a hormone produced by per tubular capillaries of kidney that promotes red blood cells production (erythropoiesis) from bone marrow by increasing proliferation and maturation of erythroidprogenitors. 13 Use of exogenous erythropoietin in CKD improves hemoglobin level, reduces risk of cardiovascular disease, and improves patient wellbeing and exercise tolerance.…”

Prevalence and factors predicting anemia in sudanese hemodialysis patients

“…The condition is defined, in adults and children older than 15 years with CKD, as hemoglobin (Hb) concentration < 13.0 g/dl (< 130 g/l) in males and < 12.0 g/dl (< 120 g/l) in females [2]. Studies conducted elsewhere have reported differing prevalence and factors associated with anemia in ESRD patients [8][9][10][11][12][13] Despite the high burden of ESRD and its complications in Sudan, there is a scarcity of published information regarding the prevalence of, and risk factors for, anemia in people with ESRD in the country. The study provides baseline information about the status of anemia in ESRD patients undergoing HD in Khartoum State and the factors affecting the control of Hb levels.…”