Factors related to erythropoietin hypo-responsiveness in patients on chronic peritoneal dialysis

Abstract

Background The present study was aimed at investigating the factors related to hypo-responsiveness to erythropoietin in patients on chronic peritoneal dialysis (PD). Methods We studied 44 patients with end-stage renal disease who had been on PD for more than 6 months and on erythropoietin (EPO) !6,000 U/ week for more than 3 months. We expressed EPO resistance index (ERI) as weekly EPO dose per hematocrit (Hct) per body weight. The dose of EPO was titrated to maintain a target Hct level between 33% and 36%. Patients were divided into two groups according to weekly EPO dose. We compared the various factors in those two groups and, by using correlation and linear regression analysis, investigated factors that might predict EPO resistance. Results There were 13 patients in the EPO <150 U/ kg per week group and 31 patients in the EPO !150 U/kg per week group. Among those 31 patients, there were five patients on EPO !300 U/ kg per week. Compared to the EPO <150 U/kg per week group, the EPO !150 U/kg per week group had a lower normalized protein catabolic rate (nPCR), lower level of serum albumin and higher C-reactive protein (CRP). Correlation analysis showed that the ERI had a statistically significant correlation with CRP (r = 0.303, P < 0.05), serum albumin (r = À0.26, P < 0.05), parathyroid hormone (PTH) (r = À0.307, P < 0.05) and nPCR (r = À0.259, P < 0.05). These results show that CRP, serum albumin, PTH and nPCR are factors related to hypo-responsiveness. Multiple stepwise linear regression analysis showed that CRP was the most important independent predictor of EPO hypo-responsiveness. Conclusion CRP, serum albumin, nPCR and PTH are factors related to hypo-responsiveness. Inflammation contributes significantly to EPO hypo-responsiveness.

Effect of silymarin administration on TNF‐α serum concentration in peritoneal dialysis patients

“…Nevertheless, it has been suggested that increased production of these cytokines may account for recombinant human erythropoietin (rhEpo) hypo-responsiveness. Therefore, reduction of infl ammatory cytokines can improve haematological status in advanced renal failure patients (Kim et al, 2001;Wei et al, 2007). In summary, these studies support the concept that silymarin antagonizes the action of pro-infl ammatory cytokines in treating infl ammatory anaemia in peritoneal dialysis patients.…”

Risk factors for high erythropoiesis stimulating agent resistance index in pre-dialysis chronic kidney disease patients, stages 4 and 5

“…When we compared the 3 groups regarding the ESA/Hb index, we observed that the main differences between groups, were related to inflammatory and nutritional parameters. These findings have been well described in patients undergoing maintenance renal replacement therapy [14,[34][35][36]. Inflammation can interact with the hematopoietic system at different levels, inhibiting erythropoietin secretion and erythroid progenitor cells maturation, increasing red blood cells destruction and decreasing iron delivery from reticuloendothelial to hematopoietic cells [12,37].…”

Neutrophil to Lymphocyte Ratio in Evaluation of Inflammation in Patients with Chronic Kidney Disease

“…Increased proinflammatory cytokines inhibit hepatic albumin and pre-albumin syntheses and also lead to erythropoiesis impairment. [19][20][21][22] Previous data have suggested close relationships between low serum albumin levels and CRP concentrations, 23 CVD development, 24 and mortality in PD and HD patients. 25,26 Low HDL-cholesterol level is related to atherogenesis, and according to our study, increased N/L ratio was accompanied by decreased HDLcholesterol levels.…”