Clinical Characteristics of Poor Responders to Erythropoietin among ESRD Patients Undergoing Hemodialysis

Cho, Jong Tae; Park, Young Sun

Abstract

BACKGROUND
The main pathogenic factor causing anemia in chronic renal failure is the erythropoietin deficiency. However, there are some patients showing poor responses to erythropoietin administration. The purposes of this study were to analyze the clinical parameters of poor responders to erythropoietin among ESRD patients undergoing hemodialysis, and to clarify the major potential factors accounting for poor responses to erythropoietin therapy. METHODS: Eighty-one patients with end-stage renal failure undergoing hemodialysis were included in this study. Poor responders to erythropoietin, defined as patients requiring erythropoietin doses more than 200 U/kg/week subcutaneously to correct anemia, were identified. The hematocrit, erythropoietin dose, erythropoietin resistance index (ERI), and other clinical parameters in 77 patients requiring erythropoietin administration were evaluated and analyzed. RESULTS: Poor responses to erythropoietin were found in 16 patients (20.8%) among 77 patients requiring erythropoietin administration. Serum iron, total iron binding capacity (TIBC), transferrin saturation (TSAT), and albumin concentration were significantly decreased (p<0.05), and increased CRP (> or =0.5 mg/dL) was more frequent in poor responders (p<0.01). The independent factor affecting on ERI was TIBC (R=0.44, p<0.01). However, there were no significant difference between poor and good responders in age, gender, duration of dialysis, underlying renal disease, use of ACE inhibitor, dose of dialysis (Kt/V), serum parathyroid hormone, and aluminum concentration. CONCLUSION: TIBC seems to be a predicting factor accounting for poor response to erythropoietin among ESRD patients undergoing hemodialysis.