Resistance to Recombinant Human Erythropoietin in Hemodialysis Patients

Tb, Drüeke

doi:10.1159/000168215

Cited by 20 publications

(9 citation statements)

References 8 publications

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“…The condition of our patient satisfies these criteria. The main causes of EPOresistant renal anemia are well known to be iron deficiency, inflammatory states, neoplastic diseases, aluminum intoxication and secondary hyperparathyroidism (5)(6)(7)(8). No iron deficiency was revealed by laboratory , data, and no inflammatory states including infection or neoplastic diseases were disclosed by chest X-ray, abdominal echography, or other examinations.…”

Section: Case Reportmentioning

confidence: 99%

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Primary Hyperthyroidism Induced Erythropoietin-resistant Anemia?

et al. 1997

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We describe a 26-year-old male hemodialysis patient with erythropoietin (EPO) resistant anemia associated with primary hyperthyroidism. Use of the anti-hyperthyroid drug, methimazole, led to improvement of his hyperthyroidism and anemia. Before the anti-hyperthyroid therapy, he had received transfusions to maintain an adequate hematocrit during recombinant human EPOtherapy. After the therapy, his hyperthyroidism improved and his hematocrit gradually increased without any transfusion. These findings suggest that the patient's EPO resistant anemia was the result of primary hyperthyroidism, and that this complication is reversible if accurate treatment is given. (Internal Medicine 36: 903-905, 1997)

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Section: Case Reportmentioning

confidence: 99%

“…However, a small number of patients remain unresponsive. The common causes of resistance are generally considered to be iron deficiency, inflammatory states, neoplastic diseases, aluminum intoxication and secondary hyperparathyroidism (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Primary Hyperthyroidism Induced Erythropoietin-resistant Anemia?

et al. 1997

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“…Human recombinant EPO corrects anaemia in the majority of the patients. However, some patients require large doses to reach an adequate haematocrit (Htc): i.e., in patients resistant to EPO and in others (<5%), Htc does not increase after EPO administration, i.e., non-responding patients [3, 4, 5, 6]. …”

Section: Introductionmentioning

confidence: 99%

Intravenous Calcitriol Improves Anaemia and Reduces the Need for Erythropoietin in Haemodialysis Patients

Goicoechea

Vázquez²,

Ruiz³

et al. 1997

Nephron

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In cases with severe hyperparathyroidism, anaemia improves after parathyroidectomy. The objective of this study was to investigate the influence of treatment with intravenous calcitriol on anaemia in 28 haemodialysis patients. The patients showed moderate to severe hyperparathyroidism (mean parathyroid hormone level 811.6 ± 327 pg/ml) and were treated with calcitriol (2 µg i.v.) after haemodialysis. The follow-up period was 12 months. 21 out of the 28 patients had been receiving erythropoietin (EPO) prior to calcitriol administration; the remaining 7 did not receive EPO. 24 patients received oral or intravenous iron. The doses of EPO and iron were modified throughout the study period to maintain a haematocrit equal to or higher than 30% and ferritin levels above 150 ng/ml, respectively. EPO needs were evaluated according to the relation EPO dose/haematocrit. We found a significant rise in haematocrit and haemoglobin at 3 and 12 months on calcitriol therapy, with no modification of the EPO dose nor ferritin levels. This improvement in anaemia was observed both in those patients who received EPO initially (p < 0.01) and in those who did not (p < 0.05). Upon dividing the patients according to the response of hyperparathyroidism to the intravenous calcitriol treatment, we observed in the responding patients (n = 19) significant increases in haematocrit (from 31.7 ± 4.2 to 36.3 ± 4.9%) and haemoglobin (from 10.6 ± 1.5 to 12.2 ± 1.5 g/dl; p < 0.001) at 12 months on intravenous calcitriol therapy, while this was not true of the non-responding patients. The EPO needs diminished in the group of responding patients and increased in the non-responders, although these changes were not statistically significant. We found no direct correlation between the decrease of parathyroid hormone and EPO needs in the group of responding patients. However, an inverse correlation between parathyroid hormone levels and EPO needs (r = –0.799, p < 0.05) was seen in the group of non-responding patients. Treatment with intravenous calcitriol in patients on haemodialysis controls secondary hyperparathyroidism, improves anaemia, and decreases the need for EPO. Studies including a larger number of patients are necessary to clarify the mechanisms underlying the improvement of anaemia upon control of secondary hyperparathyroidism with intravenous calcitriol treatment and to confirm our findings.

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“…In order for erythropoietin to be effective in promoting red blood cell synthesis, however, there must be adequate stores not only of iron but also of folate, vitamin B 6 and vitamin Although most patients on chronic folate supplementation, 1 mg/day, have serum and red cell folate levels that B 12 [4]. These same three water-soluble vitamins also participate in a complex pathway which cycles homocysteine are in the normal or high normal range, discontinuation of folate therapy can lead to folate deficiency in 5 to 10 and methionine.…”

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confidence: 99%

Vitamin Replacement Therapy in Renal Failure Patients

Makoff

1999

Mineral Electrolyte Metab

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Renal failure patients require vitamin replacement therapy that addresses the specialized needs of renal failure. Four factors including restricted diet, uremic toxins, drug-nutrient interactions, and in ESRD, the dialysis process, affect the normal absorption, retention and activity of necessary micronutrients which support all aspects of carbohydrate, protein, lipid and nucleic acid metabolism. Studies have shown that the typical renal failure diet is low in B vitamins, that uremic factors affect folate and pyridoxine activities and that many B vitamins are lost on dialysis at a rate greater than are lost with normal urinary excretion. In addition, retention of vitamin A or inappropriately high supplementation of vitamin C may cause toxicities which exacerbate existing pathologies. Further, emerging research suggests some vitamins such as folic acid and pyridoxine, if provided in higher than normal amounts, may have an impact on reducing the risk of some aspects of renal cardiovascular disease. It is therefore important to supplement some vitamins, and use restraint in the supplementation of others. It is clear that renal failure patients, including predialysis, ESRD and transplant patients need specialized supplementation that meets the requirements of disease and its management.

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Resistance to Recombinant Human Erythropoietin in Hemodialysis Patients

Cited by 20 publications

References 8 publications

Primary Hyperthyroidism Induced Erythropoietin-resistant Anemia?

Primary Hyperthyroidism Induced Erythropoietin-resistant Anemia?

Intravenous Calcitriol Improves Anaemia and Reduces the Need for Erythropoietin in Haemodialysis Patients

Vitamin Replacement Therapy in Renal Failure Patients

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