Erythropoietin Resistance in Hemodialysis Patients (original) (raw)
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Erythropoietin-Resistant Therapy in Routine Hemodialysis Patients: A Case Report
Background: Anemia in chronic kidney disease can be caused by erythropoietin deficiency. Erythropoietin stimulating agent (ESA) is the treatment of choice for anemia in patients with chronic kidney disease. Some patients for some reason fail to reach target hemoglobin levels despite maximal ESA doses. Case illustration: We reported a 58-year-old man suffering from CKD with recurrent anemia despite the maximum dose of ESA. The investigations showed secondary hyperparathyroidism due to complications of chronic kidney disorders. Discussion: Our patient's resistance to erythropoietin therapy was caused by inadequate dialysis and secondary hyperparathyroidism. The management is focused on the adequacy of hemodialysis and the management of secondary hyperparathyroidism with nutrition and medication.
Assessment Of Erythropoietin Efficacy And Dosing In Hemodialysis Patients
2021
Background: Anemia is a common complication in Chronic kidney disease (CKD) patients. It has a multi-factorial pathogenesis. Replenishing iron stores and giving ESAs are the main lines of treatment. There is a general agreement on the optimal route for iron supplementation in ESRD patients with the IV route but there is no such agreement on the optimal route for iron supplementation in pre-dialysis CKD patients. Erythropoiesis stimulating agents (ESAs) treatment represent an economic burden and has been linked to possible cardiovascular side effects. This study amid to assessing the efficacy of erythropoietin in treatment of anemia in CKD patients. Methods: A prospective cohort study was conducted in chronic kidney disease patients who had undergone hemodialysis in Met-Ghamr hospital of nephrology from February 2019 to July 2019. Included 50 patients on maintenance hemodialysis, we tested the efficacy through comparing the efficacy low fixed ESA dose (4000 IU IV once weekly) versus ...
Scientific Reports
Erythropoietin is used routinely in hemodialysis patients to increase hemoglobin levels in patients with ESRD and anemia. Considering the importance of anemia in hemodialysis patients and its complications, in this study, the effect of erythropoietin administration on blood parameters by comparing the methods of subcutaneous and intravenous administrations was investigated. The research was done as a retrospective descriptive-analytic study. The subjects were 300 hemodialysis patients receiving erythropoietin in two groups (intravenous and subcutaneous) from hospitals affiliated to Kurdistan and Kermanshah University of Medical Sciences. Data were extracted from the patients' records and entered into a researcher-made checklist during 6 months and analyzed using SPSS version 20 and descriptive and inferential statistics. The results showed that there was a significant difference between the mean rank of hematocrit in subcutaneous and intravenous injections (P-value = 0.002) and it was higher in the subcutaneous injection group. Also, independent t-test showed that there was a significant difference between the mean of hemoglobin concentration among subcutaneous and intravenous injections (P-value = 0.001) and it was higher in the subcutaneous injection group. However, there was no significant difference between the mean of ferritin in both groups (P-value = 0.084). According to the results, the injection of erythropoietin in the subcutaneous method was more effective than intravenous. It is recommended to use this approach to improve blood indices in hemodialysis patients. Chronic kidney disease (CKD) covers a range of different pathological processes associated with abnormal function of the kidney and gradual decrease of glomeruli filtration that leads to end stage renal disease (ESRD) 1. The term ERSD is used when about 90% of kidney function is lost and the body fails to keep the water and electrolyte balance, dispose of waste materials, and keep the normal function of hormones 2. There are different methods to treat kidney failure patients and hemodialysis is one and the most common of them 3. Hemodialysis patients suffer a wide range of problems and side-effects and anemia in these patients are frequently mentioned in lab reports 3. Although, other patients with renal function failure demonstrate the symptoms of anemia, the severity of the disorder in advanced renal failure patients on chronic hemodialysis is higher 4. Azhir et al. 5 reported anemia in 82% of hemodialysis patients and 48% of the cases was severe anemia 5. Anemia, according to the World Health Organization (WHO), is defined as a hemoglobin level less than 13 g/dl in men and postmenopausal women, and 12 g/dl in women before menopause. The majority of patients (90%) with glomerular filtration rate (GFR) of 25 ml/min are diagnosed as an anemia case since their hemoglobin level is less than 10 g/dl. Initiation of anemia in chronic renal failure patients is relatively faster, so that it starts when GFR is at 25-30 ml/min range 6. Anemia in renal failure patients can gradually lead to several physiological disorders such as hypoxia, cardiomegaly, increased cardiac output, hypertrophy of ventricles, angina, heart failure, cognitive and cerebral disorders, immune system failure and changes in menstrual cycle 7,8. Anemia in children might lead to growth
Folia Medica Indonesiana
Anemia is a common complication in chronic kidney disease (CKD) patient with hemodialysis. The cause of anemia is mainly due to erythropoetin deficiency because the kidneys as a erythropoetin producer are damaged. The most appropriate management of anemia in CKD with hemodialysis is the administration of Erythropoietin Stimulating Agent (ESA) or erythropoetin (Epo). The effectiveness of Epo therapy is influenced by the type of Epo used, the dose of Epo given, the route and frequency of Epo administration, as well as several conditions that affect it such as infection or inflammation, absolute and functional iron deficiency, and malnutrition. Therapeutic targets can be achieved if the dose given is in accordance with the needs of the patient, based on the patient's weight The purpose of this study was to determine the differences in the achievement of Epo-alpha fixed-dose administration compared with adjustment-dose in patients with CKD anemia with hemodialysis after administrati...
Erythropoietin Resistance Development in Hemodialysis Patients: The Role of Oxidative Stress
Oxidative Medicine and Cellular Longevity
Oxidative stress (OS) is considered a significant risk factor for the development of anemia in patients treated by regular hemodialysis (HD). Moreover, OS represents a risk factor for the development of erythropoietin (EPO) resistance in these patients. The aim of this study was to examine the role of OS regarding EPO resistance development in patients treated by regular HD. 96 patients treated with standard HD and on-line hemodiafiltration were included in this study. The patients were treated with short-acting and long-acting EPOs for anemia. The concentration of superoxide anion radical, hydrogen peroxide, thiobarbituric acid reactive substances, and nitric oxide in the form of nitrites and the activity of catalase, superoxide dismutase and reduced glutathione were measured in patients’ blood spectrophotometrically. Standard biochemical analysis, inflammatory markers, nutritional status, HD parameters, and erythropoietin resistance index were also determined. Patients with resist...
Journal of Renal Injury Prevention, 2018
Introduction: Anemia, as a common complication of end-stage renal disease (ESRD), usually develops due to erythropoietin deficiency. Recombinant human erythropoietins (rHEPOs) are indicated for the correction of renal anemia. Objectives: We aimed to evaluate the efficacy of a new brand of erythropoietin named CinnaPoietin (erythropoietin beta) on hemoglobin levels. Patients and Methods: This is a randomized double-blinded controlled trial. Ninety-six ESRD patients on hemodialysis recruited in the study, whose hemoglobin levels was less than 10 g/dL. They allocated to two groups. PDPoetin (erythropoietin alfa) 50-100 U/kg three times per week intravenously administrated to the control group and CinnaPoietin with exactly same regimen as like PDPoetin group administrated for the rest of the participants. The study duration was 3 months. We measured plasma hemoglobin monthly for 3 months. Results: We found, hemoglobin was increased across the time and it was statistically significant (P...
Folia Medica Indonesiana
Anemia in patient with chronic kidney disease could cause a lot of complication. The first line therapy of this condition is by treating with erythropoiesis-stimulating agents (ESA) or called erythropoietin. The erythropoietin alpha and beta were two types of the human recombinant erythropoietin that are usually used in Indonesia. The aim of this study was to determine the effectivity of erythropoietin alpha compared to erythropoietin beta especially in haemoglobin and haematocrit level. This prospective observational study was conducted in March – September 2016. The inclusion criteria were CKD stage 5 patients with a minimum of 3 months of regular hemodialysis, Hb <10 g/dL with enough iron status ST > 20% and FS > 200ng/mL. The methology of this study had been approved by the Health Research Ethics Committee of the Bhayangkara H.S. Samsoeri Mertojoso Hospital, Surabaya. Patients received 2000 IU subcutaneous erythropoietin twice a week on both groups. Blood sample was wit...
International Journal of Pharmacy and Pharmaceutical Sciences, 2017
Objective: To study the efficacy of intravenous erythropoietin and subcutaneous erythropoietin in hemodialysis patients who have persistent anemia despite correction of iron therapy and to measure the outcomes in terms of raise in haemoglobin concentration and adverse events in both the groups. Methods: After ethical committee approval the current study was conducted at the Department of Hemodialysis of Owasi Hospital and Research Centre, Hyderabad a period of 6 mo duration. 60 patients undergoing hemodialysis were recruited into out study who had haemoglobin less than 10.0 despite corrected iron levels. Patients were divided into two groups for intravenous administration and subcutaneous administration of alpha erythropoietin. Patients were stratified into three subgroups of mild, moderate and severe anaemia. Therapeutic response was recorded in the form of monthly hemoglobin and hemoatocrit. Of the 30 patients in the subcutaneous group, erythropoietin was given to 19 males and 11 females, while intravenous erythropoietin was administered to 17 males and 13 females in the other 30 patients. Results: The mean hemoglobin level in the subcutaneous group was 5.16 at the commencement of the study and in the intravenous group the mean hemoglobin was 5.0. In the subcutaneous group, the mean rise in the hemoglobin was rapidly achieved in 3 mo duration when compared to the intravenous group. Mean Systolic Blood pressure was higher in the intravenous group when compared to the subcutaneous group. Spillage of the drug was minimal in subcutaneous group when compared to the intravenous group. Conclusion: After correction of the iron deficiency, low dose of erythropoietin subcutaneously promised to maintain expected hemoglobin level above 10 g/dl with no adverse events compared to intravenous erythropoietin. Erythropoitin alpha at a dose of 4000 IU was enough to achieve the therapeutic target of Hemoglobin>10.0 by administering subcutaneously accelerated hypertension was less when compared to Intravenous erythropieitn post dialysis. Hence we recommend to use erythropoietin subcutaneously rather than intravenously.
Interventions for erythropoietin-resistant anaemia in dialysis patients
The Cochrane database of systematic reviews, 2013
People living with end-stage kidney disease (ESKD) often develop anaemia. Erythropoiesis-simulating agents (ESAs) are often given to people living with ESKD to maintain haemoglobin at a level to minimise need for transfusion. However, about 5% to 10% of patients with ESKD exhibit resistance to ESAs, and observational studies have shown that patients requiring high doses of ESA are at increased risk of mortality. This review aimed to study the effects of interventions for the treatment of ESA-resistant anaemia in people with ESKD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE for randomised controlled trials (RCT) that involved participants with ESKD on dialysis or who were pre-dialysis patients with chronic kidney disease (stage 5). Date of last search: April 2013. ESA resistance was defined as failure to achieve or maintain haemoglobin/haematocrit levels within the desired target range despite appropriate ESA doses (erythropoietin ≥ 45...