nPCR as an Influencing Factor on rHuEPO Response

Noh, Seung Hyun; Woo, Ha Keun; Hyeog, Kang Ki; Koh, Haeng Il

Abstract

Owing to the mass production of recombinant human erythropoietin(rHuEPO), anemia in hemodialysis patients is effectively treated by intravenous or subcutaneous injection of rHuEPO at each dialysis session. But considerable portion of patients being injected rHuEPO have the resistance of EPO treatment. The most common cause of EPO resistance is caused by functional and storage iron deficiency and followed by chronic inflammation, hyperparathyroidism and aluminum intoxication in its incidence. But the rHuEPO resistance is not fully explained by these causes. In the present study, the relationship between nPCR reflecting daily protein intake and the weekly doses of rHuEPO required to maintain hemoglobin levels at approximately 10gm/dL was analyzed in 34 hemodialysis patients All subjective patients of 34 hemodialysis were injected rHuEPO subcutaneously and divided into two group:Group A composing 22 hemodialysis patients is nPCR<1.0gm/kg/day and Group B with 12 hemodialysis patients is nPCR>=1.0gm/kg/day. There were no significant differences in age, duration of hemodialysis, serum ferritin, serum iron, TIBC, transferrin saturation(%) of each group. The patients who had serum ferritin below 100 micro gm/dL or transferrin saturation(%) below 20% were excluded in this study. The weekly rHuEPO doses in patients with Group B was lower than those of patients with Group A(58.7627+/-20.465IU/kg/week vs 80.4317+/-38.6258IU/kg/week, P=0.041). Moreover Serum albumin levels in Group A were significantly lower than those of Group B(3.6522+/-0.4461gm/dL vs 4+/-0.3606gm/dL, P=0.031) and Kt/V in Group B were significantly higher than those of Group A (1.145+/-0.2049+/-1.4021+/-0.2981, P=0.021). Serum parathyroid hormone levels were significantly higher in Group A than those of Group B(171.9783+/-150.3378 pg/dL vs 72.8809+/-79.7226 pg/dL, P=0.049). But other various factors including serum aluminum, body mass index and acute phase reactant proteins such as C-reactive protein and ESR had no significant differences in each group.
CONCLUSION
Our result showed that nPCR presenting daily protein intake is related with rHuEPO response and the patient's nutritional status. So we think that the nutrition aspect in EPO treatment should be considered. However, to prove this relationships completely between nutritional factors and rHuEPO response, further study shoud be needed.