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Kidney Week

Abstract: PO0899

Prevalence of Anti-Erythropoietin Antibodies in Patients with ESRD on Regular Hemodialysis: A Single-Centre Experience

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Keeppallil, Kevin T John, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
  • Shekar, Manikantan, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
  • Elumalai, Ramprasad, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
Background

Recombinant human erythropoietin (rHuEPO) is a glycoprotein that acts as a biological substitute for the endogenous substance used to treat anaemia in individuals with end-stage renal failure. Patients with rHuEPO resistance have been described, requiring higher and higher dosages of the drug to maintain an appropriate haemoglobin level. These antibodies probably cross react with the patient’s endogenous EPO and lead to anemia that can be more severe than even before the onset of EPO therapy.The prevalence of anti-erythropoietin antibodies in renal patients who respond poorly to erythropoetin is unknown.

Methods

We screened 262 patients who were on maintenance haemodialysis and excluded patients who were malnourished and had chronic liver disease, hypothyroidism, ongoing active autoimmune disease, active infection, on steroid therapy, with bleeding or hemolysis and elderly. 96 ESRD patients who were on recombinant human erythropoietin > 6 months and hemoglobin < 10 g /dL were included. Serum anti-EPO antibodies were detected by enzyme-linked immunosorbant assay technique. All patients were subjected to full history taking and clinical examination. Complete blood count, reticulocytes count, serum creatinine, blood urea, serum albumin, serum ferritin, and hepatitis markers were performed for all patients.

Results

Results showed that 26 patients (27.08%) had the anti-EPO antibodies in their blood, while 70 patients (72.91%) did not have the circulating antibodies. The mean hemoglobin (Hb) level was significantly lower in the antibody positive group (8.4 g/dl ± 1.52) than in the antibody negative group (9.68 g/dl ± 1.14) (P = 0.000). The dose of EPO administrated in both studied groups were significantly different. Logistic regression analysis also revealed that gender or age were not associated with any significant variation of serum antibody level. High levels of serum antibodies to EPO are a risk factor for EPO resistance.

Conclusion

Many anaemic ESRD patients treated with recombinant human erythropoetin have a low-affinity immune response to the recombinant protein that is readily detected. Antibodies to rHuEPO were shown to be greater in patients who received high EPO weekly dose. More research into anaemia management protocols in HD patients with positive anti-EPO antibodies is needed.