Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.
Journal Title: IOSR Journal of Pharmacy and Biological Sciences (IOSR-JPBS) - Year 2017, Vol 12, Issue 3
Abstract
Introduction: Erythropoietin-stimulating agents (ESA) enables the correction of anemia in patients on maintenance hemodialysis (HD) but ESA resistance remains incompletely understood among HD patients. Objectives: to examine variations in the response to erythropoietin (Epo) and identify factors which influence it. Patients and Methods: Prospective observational study conducted over 12 months on Egyptian patients on maintenance HD. The response to Epo was estimated by erythropoietin resistance index (ERI), defined as Epo dosage over a week divided by the post-HD weight and Hgb value. Results: The study included 89 patients (40.45% males) of avarage age 54.16 years, who had been on maintenance HD for average 94.47 months. Different ESA doses were needed to achieve and maintain the target Hgb range. The individual weekly dose of ESA ranged from 14.29 U/kg/week to 196.96 U/kg/week and of the ERI ranged from 1.22 U/kg/week/g/dl to 17.13 U/kg/week/g/dl. A satisfactory Epo response with ERI below 5 U/kg/week/g/dl was found in 33.7% of patients, while 23.6% had average ERI above the 10 U/kg/week/g/dl, indicating that the percentage of patients with a poor response to Epo is not negligible. Multivariate analysis revealed serum albumin, transferrin saturation and statins use to be inversely related to ERI, whereas Creactive protein(CRP), dialysis dose (spKt/V), angiotensin-converting enzyme inhibitor(ACEI)/ angiotensin receptor blocker(ARB) use and intact parathyroid hormone (iPTH) were associated with higher ESA resistance. Conclusion: Target Hgb levels were achieved and maintained by different doses of Epo in individual patients as a result of large individual variations in the response to ESA estimated by the ERI. Serum albumin and CRP were the strongest independent predictors of ERI.
Authors and Affiliations
Abdel-Hameed I. M. Ebid1, Amira M. Elsawy, Waleed A. Taha2
Keywords
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- EP ID EP389294
- DOI 10.9790/3008-1203044050
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