La antiagregación plaquetaria incrementa los requerimientos de eritropoyetina en pacientes en hemodiálisis

Abstract

BackgroundThe optimal use of human recombinant erythropoietin therapy is important to maximize the effectiveness of treatment of anemia and cost-effectiveness in hemodialysis (HD) patients. To achieve this, all the factors that can counteract the positive action of erythropoietin therapy should be identified. ObjectiveTo evaluate the possible influence of antiplatelet therapy on erythropoietin requirements in HD patients. Patients and methodA cross-sectional study was performed in 181 HD patients with autologous arteriovenous fistulae (55% males; mean age 65±14 years). Data were collected in 10 hemodialysis units in Aragon (Spain). Patients were divided into 2 groups according to whether they were receiving antiplatelet therapy or not. ResultsHemoglobin levels were similar in the 2 groups but erythropoietin requirements were higher in patients on antiplatelet therapy (129.8±59.8 versus 103.2±62.2 U/kg/week, p=0.0094). No differences between the 2 groups were found that could explain this finding. When diabetic patients were analyzed separately, erythropoietin doses were higher in the group of patients on antiplatelet therapy than in those not on antiplatelet drugs (130.9±58.2 versus 94.7±39.1 U/kg/week, p=0.0357). Multiple regression analysis revealed that antiplatelet therapy, low serum ferritin, low serum calcium, and high serum aluminium levels were independent predictors of erythropoietin hyporesponsiveness. In a subgroup of 95 patients in whom absolute lymphocyte count was available, patients on antiplatelet therapy showed lower lymphocyte count (1,127±394 versus 1,432±520 lymphocytes/μl, p=0.006) and higher erythropoietin requirements (138.6±63.1 versus 109.9±61.5 U/kg/week, p=0.0393) than individuals not on antiplatelet therapy. ConclusionsThe present study suggests that antiplatelet therapy may be an important factor in determining erythropoietin requirements in HD patients.