Resistance of dialyzed patients to erythropoietin

Abstract

Resistance to recombinant human erythropoietin is a common condition in dialyzed patients with chronic kidney disease and is associated with more hospitalizations, increased mortality and frequent blood transfusions. The main cause of hyporesponsiveness to recombinant human erythropoietin in these patients is iron deficiency. However, a high proportion of patients does not respond to treatment, even to the use of intravenous iron, which indicates the presence of other important causes of resistance. In addition to the iron deficiency, the most common causes of resistance include inflammation, infection, malnutrition, inadequate dialysis, and hyperparathyroidism, although other factors may be associated. In the presence of adequate iron stores, other causes should be investigated and treated appropriately.

Factors Contributing to Erythropoietin Hyporesponsiveness Among Hemodialysis Patients: A Cross-Sectional Multicenter Study

“…With respect to dialysis adequacy, both group had similar mean Kt/V (1.2 ± 0.2 vs. 1.24 ± 0.3, P > 0.05), but surprisingly, greater percentage of patients with EHRI > 16.49 had Kt/V above 1.4. Our findings were not in the same line with previous findings in this regard (11,14).…”

“…Inhibition of renin angiotensin system inhibits erythropoiesis by decreasing angiotensin II availability, which is a growth factor for erythrocytes (12). Also, ACE inhibition can lead to elevated level of negative regulator of erythropoiesis of acetyl-seryl-aspartyl-lysyl-proline (AcSDKP) (11).…”

Circulating Antibodies to Erythropoietin Are Associated With Lower Efficacy of Recombinant Epoetin Treatment in Patients Undergoing Haemodialysis

“…Рядом исследователей было обнаружено, что у большей части пациентов, долгое время по-лучавших препараты рЭПО, синтезировались антитела (анти-рЭПО) против данного ГИБП [5,6,4]. Можно предположить, что анти-рЭПО На базе научно-исследовательского института нефрологии ПСПбГМУ имени акад.…”

“…Напротив, не-которые данные указывают на низкую распро-страненность анти-рЭПО антител у пациентов с ХБП, получавших гемодиализ (1,11%), что, возможно, объясняется гетерогенностью групп пациентов, этиологией ХБП, различиями в мето-дике определения титра анти-рЭПО антител [5]. Полученные данные о более высокой кон-центрации анти-рЭПО в группе пациентов СОТ и обратной связи между их концентраци-ей и средними значениями гемоглобина и эри-троцитов могут косвенно указывать на влияние этих иммуноглобулинов на терапевтическую ак-тивность стимулирующих гемопоэз препаратов.…”

Haemolysis in haemodialysis

“…Increases in erythropoietin requirements in iron replete patients should alert one to be possibility of chronic haemolysis …”