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Colegio de Medicina Interna de México.

2015, Number 2

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Med Int Mex 2015; 31 (2)

Anemia and inflammation with the administration of erythropoiesis stimulants and its resistance in hemodialysis

Rodríguez RMB, Castro-D’Franchis LJ, Reyes-Jiménez AE, López-Urtiz CA

Language: Spanish
References: 32
Page: 155-163
PDF size: 591.08 Kb.


ABSTRACT

Background: Erythropoietin deficiency is the dominant factor of anemia in patients with chronic kidney disease. Diagnosis in stage 3, 4 and 5 is set to less than 11 g/dL hemoglobin. The effectiveness of the response to erythropoietic stimulation can be evaluated with the erythropoietin resistance index (ERI), that expresses the relationship between the administered dose of stimulating agents and hemoglobin concentrations defining resistance with an ERI ≥ 10.
Objective: To determine if there is a significant difference between the resistance index to erythropoietin and the kind of erythropoietin administering epoetin beta vs beta methoxy polyethylene glycol.
Material and method: An observational, prospective, longitudinal and comparative study was done in patients of the Hemodialysis Unit of the North Central Hospital, Pemex, Mexico City, with two types of recombinant erythropoietin. Hemoglobin, iron kinetics, parathyroid hormone, C-reactive protein (CRP), albumin, absolute and relative frequencies, correlating variables using Pearson’s coefficient were measured.
Results: Of all patients a significant difference between the ERI and the type of erythropoietin (p ‹0.05) was observed, with a mean hemoglobin of 9.5 g/dL in patients treated with epoetin beta vs 10.08 g/dL receiving epoetin beta methoxy polyethylene glycol; inverse correlation between CRP and hemoglobin levels.
Conclusions: Increased C-reactive protein and anemia influence on erythropoietin resistance administering two different types of erythropoietin.


REFERENCES

  1. Lorenzo y D. Causas de resistencia al tratamiento con eritropoyetina recombinante humana. Nefrología 1992;XII.

  2. Ribeiro S, Costa E, et al. rhEPO for the treatment of erythropoietin resistant anemia in hemodialysis patients–risks and benefits. Hemodial Int 2013;493-500.

  3. Drüeke TB, Eckardt KU. Role of secondary hyperparathyroidism in erythropoietin resistance of chronic renal failure patients. Nephrology Dialysis Transplantation 2002;17:28-31.

  4. Locatelli F, Nissenson A, et al. Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). International Society of Nephrology. 2008.

  5. Costa E, Belo L, et al. Resistance to recombinant human erythropoietin therapy in haemodialysis patients-focus on inflammatory cytokines, leukocyte activation, iron status and erythrocyte damage. J Nephrol Ren Transplant 2009;2:66-83.

  6. Phrommintikul A et al. Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta-analysis. Lancet 2007;369:381-388.

  7. Adriam L Goram. Factors and predictors of response with epoetin alfa for chemotherapy-related anemia. J Pharm Technol 2000;16:227-235.

  8. KDIGO. Clinical Practice Guideline for Anemia in Chronic Kidney Disease, 2012;2.

  9. Parodis López, Y, Quintana Viñau, et al. Resistencia a la eritropoyetina en paciente trasplantado renal que regresa a hemodiálisis. Nefrología Sup Ext 2012;3:52-57.

  10. Schneider A, Schneider MP, et al. Predicting erythropoietin resistance in hemodialysis patients with type 2 diabetes. BMC Nephrology 2013;14:67.

  11. López Gómez JM, de Francisco Al, et al. Evolución del índice de resistencia a darbepoetina alfa en pacientes dializados que cambian de administración semanal a quincenal en la práctica clínica. Nefrología 2010;30:64-72.

  12. EMEA Public Statement. Epoetins and the risk of tumour growth progression and thromboembolic events in cancer patients and car- diovascular risks in patients with chronic kidney disease. London, 2007. Doc. Ref. EMEA/496188/2007. Disponible en: http:// www.emea.europa.eu

  13. Valderrábano F, Alamo Caballero C, Alijama García P, Alonso Hernández A, et al. Eritropoyetina humana recombinante. Barcelona: Masson, 1988;5-10.

  14. Herrera Valdés R, Román Aldana W, Soto León L, Pérez Oliva-Díaz J, et al. Insuficiencia renal crónica. En: Temas de Nefrología. La Habana: Editorial Ciencias Médicas, 1991;2:3-4.

  15. Díez JJ, Iglesias P. Acciones de la eritropoyetina humana recombinante sobre la secreción hipofisiaria en pacientes urémicos. Nefrología 1993;XIII;380-390.

  16. Jelkmann WE. Regulation of erythropoietin production. J Physiol 2011;589:1251-1258.

  17. National Collaborating Centre for Chronic Conditions. Anaemia management in chronic kidney disease: national clinical guideline for management in adults and children. London: Royal College of Physicians, 2000.

  18. Oster W, Hermann F, Gamm H. Erythropoietin for the treatment of anemia of malignancy associated with neoplastic bone narrow infiltration. J Clin Oncol 1990;8:956- 962.

  19. McMahon FG, Vargas R. Ryan. Pharmaokinetics and erytrhopoietic response to human recombinant erytrhropoietin in healthy men. Clin Pharmacol Ther 1990;47:557-564.

  20. Sobota JT. Recombinant human erytropoietin in patients with anemia due to end-stage renal disease. USA multicenter trial. Contrib Nephrol 1989;76:166-178.

  21. Zehnder C, Blumbert A. Human recombinant erythropoietin treatment in transfusión-dependent anemic patients on maintenance hemodyalisis. Clin Nephrol 1989;31:55-59.

  22. Singh AK, Szczech L, Tang KL, Barnhart H, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006;355:2085-2098.

  23. Panichi V, Rosati A, Bigazzi R. Anaemia and resistance to erytropoiesis-stimulating agents as prognostic factores in haemodialysis patients: results from the RISCAVID study. Nephrol Dial Transplant 2011;26: 2641-2648.

  24. Palmer SC, Navaneethan SD, Craig JC. Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease. Ann Intern Med 2010;153:23-33.

  25. Guía de Práctica Clínica, Prevención, Diagnóstico y Tratamiento de la Enfermedad Renal Crónica Temprana. México: Secretaría de Salud, 2009.

  26. Bárány P. Inflammation, serum C- reactive protein, and erythropoietin resistance. Nephrol Dial Transplant 2001;16:224-227.

  27. Van der Putten K, Braam, et al. Mechanisms of disease: erythropoietin resistance in patients with both heart and kidney failure. Nature Clinical Practice. Nephrology 2008;1:47-57.

  28. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 2006;47. Locatelli F, Nissenson A, et al. Clinical practice guidelines for anemia in chronic kidney disease: problems and solutions. A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). International Society of Nephrology, 2008.

  29. Guerrero Riscos MA, Montes Delgado R, et al. Resistencia a eritropoyetina y supervivencia en pacientes con enfermedad renal crónica 4-5 no–D y enfermedad cardiaca. Rev Nefr 2012;32:343-352.

  30. Khatib M. The role of inflammation on iron and erithropoietin resistance. J Nephrol RenTransplant 2009;2:45-54.

  31. Campise M, Mikhail, et al. Impact of pre-transplant anaemia correction and erythropoietin resistance on long-term graft survival. Neprhol Dial Transplant 2005;20:8-12.

  32. Cavill I. Iron status as measured by serum ferritin: the marker and its limitations. Am J Kidney Dis 1999;34:s12-17.




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