Hyporesponsiviness to Erythropoietin Therapy in End Stage Renal Disease Patients on Regular Haemodialysis

Abstract

<i>Background:</i> Many factors can alter the response to erythropoietin treatment and approximately 5–10% of patients present an evident resistance in response to erythropoietin therapy. These include: iron deficiency, inflammation, infections, malignancy, dialysis, blood loss, hyperparathyroidism, aluminum toxicity and vitamin B12 or folate deficiencies. <i>Objective:</i> To evaluate and search for causative factors that predispose to Anemia resistance to erythropoietin therapy in End stage renal failure patients on regular hemodialysis. P<i>atients and methods:</i> This is descriptive prospective study enrolling 350 patients with End stage renal disease on regular hemodialysis, during January 2019 to January 2020 at Al-Emamain Al-Kadumian Medical City / Nephrology unit. 117 (44 female and 73 male) patients enrolled in this study whom met the inclusion criteria: Hgb level below 11 mg / dl despite adequate erythropoietin dose, regular adequate HD, Iron and folic acid supplementation. Amonthly bases measurement of CBC, CRP, S. Albumin, S. Ca, S. Phos, S. PTH, S. Ferritin and Transferrin Saturation were obtained. <i>Results:</i> 39% of patients have anemia resistance to erythropoietin. 48.7% of cases were taking Angiotensin converting enzyme inhibitors or angiotensin receptor blockers while 51.3% not. Hemoglobin level was significantly affected with ACEi or ARBs drugs use 8.20±1.17 mg/dl with drug use versus 8.95±0.82 mg/dl without ACEi or ARBs (p value <0.001). Hemoglobin level average was 7.85±1.01 mg/dl in female patients while 8.99±0.87 in male patients (p value<0.001). The mean WBC 7799 ± 2278 ×10³/mm³ shows negative effect on Hgb level (p value < 0.001), The Hgb level was negatively corelated with serum ferritin level (mean S. ferritin 592.9577 ± 270.707ng/ml) (p value 0.031). CRP level negatively corelate with Hgb level (p value< 0.001) while Albumin Level Positively corelated (p value < 0.001). Regarding Parathyroid, S. Ca and S. Pho level impacts on Hgb level shows negatively correlate of Hgb with PTH (mean 691.7144±324.66 pg/ml)(p< 0.001) and S. Pho (mean 5.4637 ± 1.01585 mg/dl) (p value 0.024) and positive correlate with S. Ca (8.40744± 0.660188 mg/dl) (p value 0.023). <i>Conclusion:</i> The level of hemoglobin response to erythropoietin is significantly affected by Gender (female require higher dose), ACEi and ARBs treatment, WBC, CRP, Serum Albumin, Serum Calcium, Serum Ferritin, Serum Phosphorus and Serum Parathyroid hormone.