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Kidney Week

Abstract: TH-PO949

Risk Factors Involved in Erythropoietin Resistance in Patients with CKD in a Hemodialysis Unit

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Diaz Garcia, Juan Daniel, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Maldonado Tapia, Diana, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Morales Lopez, Enrique Fleuvier, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Ortega, Jose Luis, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Hernandez Copca, Francisco Javier, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Cerezo Samperio, Beatriz Rocío, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Ramirez, Irving Gaston, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Nieto, Julio Cesar, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Compean, Abel Humberto Villanueva, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Alamilla-Sanchez, Mario, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
Background

Recombinant human erythropoietin is administered to patients with end-stage chronic kidney disease for the treatment of anemia. However, there are different factors that generate resistance to this treatment. This paper seeks to evaluate the impact of a structured team approach for the management of anemia in erythropoietin-resistant hemodialysis patients.

Methods

Prospective study of 18 months. A total of 27 patients in a hemodialysis unit of a reference center, where erythropoietin resistance was defined as those patients who had erythropoietin >300 units/kg/week. Hemoglobin, iron indices, parathyroid hormone, folate, vitamin B12, and reticulocyte counts were determined at baseline. Said previous parameters were followed every 6, 12 and 18 months. The target hemoglobin was 10-12 g/dl. All factors potentially contributing to erythropoietin resistance were evaluated and, if possible, treated every 4 weeks by a specialized nephrology team. Downward erythropoietin dose adjustments of 12.5 to 25% to the nearest 1000 units were considered if the underlying causes of resistance could not be identified or reversed, or if hemoglobin exceeded the target level.

Results

Parathormone levels and iron deficiency were the predominant treatable factors associated with erythropoietin resistance. At 4 months, mean erythropoietin dose decreased significantly from 469 to 319 units/kg/week (p < 0.001) and mean hemoglobin increased significantly from 10.6 to 11.6 g/dl (p = 0.023), a At 8 months, the patients had erythropoietin doses of less than 300 units/kg/week, reaching target hemoglobin levels.

Conclusion

A structured team approach of nephrologists and a monthly adaptation with an individualized management of the patient managed to significantly reduce the dose of erythropoietin with an improvement in serum hemoglobin reaching the objectives set in the international guidelines, identifying and solving the factors involved.