HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Erythropoietin Resistance in the Treatment of the Anemia of Chronic Renal Failure

Priyadarshi, Anumeet; Shapiro, Joseph I.

doi:10.1111/j.1525-139x.2006.00172.x

Cited by 41 publications

(36 citation statements)

References 73 publications

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“…The use of EPO in ESRD patients results in a significant increase in Hb concentration and improvements in quality of life for the majority of patients. Approximately 5-10% of ESRD patients receiving EPO, however, appear to be resistant to this drug (Priyadarshi and Shapiro, 2006).…”

Section: Discussionmentioning

confidence: 99%

Polymorphisms in two genes, IL-1B and ACE, are associated with erythropoietin resistance in Korean patients on maintenance hemodialysis

et al. 2008

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Genetic polymorphisms may be linked to inter-individual differences in erythropoietin (EPO) resistance. We investigated the -511C/T polymorphism of the IL-1B gene and the I/D polymorphism of the ACE gene for any association with EPO resistance index (ERI) in maintenance hemodialysis patients (n = 167). Because EPO responsiveness is multi-factorial, we also included other possible influences (age, sex, time on dialysis, ACE inhibitor or angiotensin receptor blocker use, ferritin, transferrin saturation, intact PTH, high sensitivity C-reactive protein, albumin, Kt/V, and presence of diabetes mellitus) on ERI in our analyses. Multiple regression analysis showed significant association of the IL-1B-511CC and ACE DD polymorphisms with ERI (P = 0.038 and P = 0.004 in the recessive model, respectively). The combination (C) of alleles of two loci showed that C1 (I-T) was significantly associated with ERI in the co-dominant and recessive models (P = 0.005 and P = 0.0001, respectively). Subjects who did not carry C1 showed significantly decreased ERI (10.10 ± 5.15 IU/kg weight/g hemoglobin) compared to other study subjects (C1/C1 and C1/-; 12.97 ± 4.90 and 15.12 ± 7.43 IU/kg weight/g hemoglobin, respectively). Our study indicates that the IL-1B-511C/T and ACE I/D polymorphisms may be useful genetic markers of EPO requirement in hemodialysis patients. These findings might also provide a new perspective on therapeutic approaches to the treatment of end stage renal disease patients with anemia.

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Section: Discussionmentioning

confidence: 99%

Polymorphisms in two genes, IL-1B and ACE, are associated with erythropoietin resistance in Korean patients on maintenance hemodialysis

et al. 2008

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“…54 In dialysis patients, blood samples drawn at the beginning of the week may have lower hemoglobin values as a result of hemodilution as compared with midweek draws. 55 Additional reasons for hemoglobin variability include acute or chronic comorbidities 17 ; alteration in iron stores 56 ; infection or inflammation 57,58 ; blood loss or transfusion 59 ; dialysis treatment features such as dialysis adequacy 60 or water quality 61 ; stage of CKD and residual renal function 31 ; level of parathyroid hormone 62 ; vitamin and mineral status such as vitamin D, B 12 , or folate deficiencies 63 ; and seasonal effects. 61 Hemoglobin variability is more prominent in patients who are younger, have lower albumin or higher serum ferritin levels, or have changes in appetite 64 possibly related to alterations in nutritional or inflammatory status 57 and higher mean corpuscular hemoglobin.…”

Section: Patient-related Factorsmentioning

confidence: 99%

Hemoglobin Variability in Anemia of Chronic Kidney Disease

Kalantar-Zadeh

Aronoff

2009

Journal of the American Society of Nephrology

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“…Mechanisms involving iron deficiency or utilization, deficiency of other nutrients, infections and inflammation, uremic toxins and inadequate dialysis are some of the main pathways believed to contribute to episodes of such resistance. An inadequate response to EPO therapy is defined as failure to achieve or maintain target Hb/Hct levels in the presence of adequate iron stores at specified intravenous or subcutaneous doses of EPO within a certain period of time [64]. Dialysis therapy not only impacts the processes of bone marrow erythropoiesis, circulating erythrocytes, uremic toxicity and inflammation, but anemia therapy itself – particularly EPO resistance [63].…”

Section: Dialysis Strategies That Affect Anemia Therapymentioning

confidence: 99%

Impact of Hemodialysis Therapy on Anemia of Chronic Kidney Disease: The Potential Mechanisms

Bowry

Gatti

2011

Blood Purif

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A significant and increasing number of chronic kidney disease (CKD) patients are treated with online hemodiafiltration (OL-HDF), even in the absence of more conclusive survival data. OL-HDF affords several clinical benefits including control of anemia of CKD, a common affliction in dialysis patients. In efforts to understand the underlying mechanisms that contribute to the purported benefits of OL-HDF, we examined the potential role and impact of OL-HDF on key stages of anemia and its correction: erythropoiesis of bone marrow, circulating erythrocytes and on anemia therapy. We review evidence that indicates OL-HDF may modulate key processes of anemia and its therapy, including underlying conditions and responses of uremic toxicity and inflammation that aggravate anemia. Our assessment indicates that OL-HDF favorably impacts anemia by not only eliminating putative uremic inhibitors that suppress erythropoiesis, reducing red cell destruction and increasing iron availability, but also by mechanisms restricting underlying inflammation and endothelial dysfunction that are crucial to both CKD and anemia.

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HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Erythropoietin Resistance in the Treatment of the Anemia of Chronic Renal Failure

Abstract: Resistance to erythropoietin therapy is a common complication of the modern management of anemia in chronic kidney disease. Iron deficiency, deficiency of other nutrients, toxins, infections, and inadequate dialysis account for the vast majority of episodes of such resistance.

Cited by 41 publications

References 73 publications

Polymorphisms in two genes, IL-1B and ACE, are associated with erythropoietin resistance in Korean patients on maintenance hemodialysis

Polymorphisms in two genes, IL-1B and ACE, are associated with erythropoietin resistance in Korean patients on maintenance hemodialysis

Hemoglobin Variability in Anemia of Chronic Kidney Disease

Impact of Hemodialysis Therapy on Anemia of Chronic Kidney Disease: The Potential Mechanisms

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