European Best Practice Guidelines 14–16 Inadequate response to epoetin

Abstract

(n=370), comparative analyses would be inappropriResults ate. For the group of ‘high-dose’ patients, only 31.4% had haemoglobin levels of 11.0 g/dl; 29.7% had levels Key points from the EBPG between 10.0 and 10.9 g/dl, 21.1% between 9.0 and 9.9 g/dl, and the remaining 17.8% below 9.0 g/dl $ A need for >300 IU/kg/weekly epoetin defines an (Figure 39). The mean serum ferritin level was inadequate response (‘resistance’). 481.2 mg/l (SD=472.9) and the mean transferrin $ Iron deficiency (absolute or functional ) is the most saturation (TSAT) was 25.1% (SD=13.2). Of 313 common cause of an inadequate response to patients for whom serum ferritin values were available, epoetin although patients must be screened for 36 (11.5%) had levels <100 mg/l; 87 of 223 patients other causes, such as raised iPTH, malignancy, (39.0%) had a TSAT of <20%. The mean C-reactive infection/inflammation, aluminium toxicity, etc. protein (CRP) for this ‘high-dose’ group was 21.8 mg/l with a median of 10.0 mg/l (SD=29.5).The mean Key findings from ESAM iPTH level was 191.9 pg/ml with a median of 93.0 pg/ml (SD=283.8) and the mean serum alumi$ Of the 370 patients receiving an epoetin dose 300 nium level was 3.7 mmol/l (median=1.0 mmol/l, SD= IU/kg/week, almost 70% had haemoglobin levels 4.9). There was a fairly marked skew in the distribution <11.0 g/dl. More than a third of the patients in of these parameters. The mean age for this small cohort this high-dose category received no iron during was 58 years (SD=16.1), Kt/V ranged from 0.6 to 2.2 month 1 of the study. with a mean of 1.3 (median=1.3, SD=0.3). These $ Angiotensin-converting enzyme (ACE) inhibitor patients received on average 20.2 mg/day of ACE therapy does not appear to affect the response inhibitor medication (median=10.0, SD=28.6). to epoetin. Approximately 38.2% of the patients in this dose category received no iron at month 1, while 3.7% Table 25 compares data for haemodialysis patients received oral and 58.1% received i.v. iron. with an epoetin dose 300 IU/kg/week vs <300 Epoetin dose and achieved haemoglobin may vary IU/kg/week (in month 1). Since the cohort of patients with an epoetin dose 300 IU/kg/week is very small in relation to concomitant pathology with which