Korean J Med.  2000 May;58(5):510-515.

Determinants of erythropoietin resistance in hemodialysis patients: EPO Resistance in HD patients

• Kwon KH
• Hwang KH
• Kim KS

Abstract

BACKGROUND
More than 90% of dialysis patients respond in a dose-dependent manner to erythropoietin(EPO) administration and the others are resistant. The causes of EPO resistance are iron deficiency, vitamin deficiency, severe hyperparathyroidism, aluminum toxicity, and inflammation. Much literature has been published concerning iron deficiency and its role in EPO resistance. However little attention has been given to the contribution of inflammation to the EPO-resistant anemia observed in hemodialysis patients.
METHODS
In the present study, we examined the contribution of parathyroid hormone levels, iron idices, normalized protein catabolic rate(nPCR), Kt/Vurea, albumin, and C-reactive protein(CRP) to erythropoietin resistance index(weekly rhEPO dose/body weight/hematocrit; ERI) in clinically stable 48 hemodialysis patients.
RESULTS
The factors correlated with ERI were CRP(R=0.608, p< 0.01), ferritin(R=0.460, p< 0.01) and serum albumin(R=-0.359, p< 0.05). In stepwise multiple regression analysis, the independent factor affecting on ERI was CRP(beta=0.620, p< 0.01). Comparing high CRP group(> or =0.4 mg/dL) with normal CRP group(<0.4 mg/dL), there were significant differences in serum albumin, creatinine, ferritin, and ERI.
CONCLUSION
Acute-phase response, assessed by the level of CRP, was the most important predictor or EPO resistance in stable hemodialysis patients.

Keyword

C-reactive protein; Erythropoietin resistance; Albumin; Ferritin

MeSH Terms

Acute-Phase Reaction
Aluminum
Anemia
Avitaminosis
C-Reactive Protein
Creatinine
Dialysis
Erythropoietin*
Ferritins
Humans
Hyperparathyroidism
Inflammation
Iron
Parathyroid Hormone
Renal Dialysis*
Serum Albumin
Aluminum
C-Reactive Protein
Creatinine
Erythropoietin
Ferritins
Iron
Parathyroid Hormone
Serum Albumin