FACTORS CONTRIBUTING TO THE RECOVERY FROM ANEMIA IN HEMODIALYSIS PATIENTS DURING THE ADMINISTRATION OF RECOMBITANT ERYTHROPOIETIN

  • Tanja Boljevic Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica
  • Damir Pelicic Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica
Keywords: hemodialysis, erythropoietin, chronic kidney insufficiency

Abstract


Introduction/Aims: Anemia is the commonest complication in patients on a chronic hemodialysis program and is the cause of reduced quality of life. The aim of this study was to identify the factors that contribute to the better control of anemia with the help of recombinant erythropoietin in persons undergoing hemodialysis.

Methods: The cross-sectional study was conducted in 2017 and it included 52 persons on hemodialysis at the Clinical Center of Montenegro. The participants were divided into those, in whom hemoglobin values increased to satisfactory values (110 g/l or more) after three months of application of recombinant erythropoietin (group 1), and those, in whom hemoglobin values were lower than 110 g/l (group 2). Data were collected from the medical history of all participants. T-test was used for the statistical analysis of data.

Results: After the three-month administration of erythropoietin, the target value of hemoglobin of 110 g/l or more (group 1) was achieved in only 21 patients (40.4%), while hemoglobin values were below 110 g/l in 59.6% of patients. Participants, in whom target values of hemoglobin were not achieved, received significantly higher average doses of erythropoietin and they had higher body mass index in comparison to participants, in whom the target values were achieved. There was no significant difference between the examined groups regarding the response to erythropoietin, duration of erythropoietin therapy, duration of hemodialysis, participants’ age, skin-fold thickness, upper arm width, transferrin values, number of erythrocytes, value of albumin, hemoglobin, hematocrit and iron.

Conclusion: Possible factors that contribute to worse control of anemia are higher doses of erythropoietin and greater level of nutritional status estimated according to the body mass index. Further research is necessary aimed at finding factors that would contribute to the elimination of anemia in persons on hemodialysis, because non-treated anemia may lead to numerous unfavorable outcomes (poor quality of life, cardiovascular diseases, cerebrovascular insult, decreased survival rate etc.).

References

1. Jacović S, Jovanović M, Hamzagić N, Pavlović R, Petrović D. Rezistencija na eritropoetin kod bolesnika na hemodijalizi. Acta Facultatis Medicae Naissensis 2019; 36(1):5-14. doi: 10.2478/afmnai-2019-0001

2. Sosnin DY, Khovaeva YB, Podyanova AI, Syromyatnikova TN, Nenasheva OY. [Eritropoetin as laboratory index of the degree of respiratory insufficiency in chronic obstructive pulmonary diseases.]. Klin Lab Diagn 2018; 63(11):691-5. doi: 10.18821/0869-2084-2018-63-11-691-695.

3. Sakaguchi Y, Hamano T, Wada A, Masakane I. Types of Erythropoietin-Stimulating Agents and Mortality among Patients Undergoing Hemodialysis. J Am Soc Nephrol 2019; 30(6):1037-48. doi: 10.1681/ASN.2018101007

4. Georgianos PI, Agarwal R. Systolic and diastolic hypertension among patients on hemodialysis: Musings on volume overload, arterial stiffness, and erythropoietin. Semin Dial 2019; 32(6):507-12. doi: 10.1111/sdi.12837

5. Aapro M, Krendyukov A, Schiestl M, Gascón P. Epoetin Biosimilars in the Treatment of Chemotherapy-Induced Anemia: 10 Years' Experience Gained. BioDrugs 2018; 32(2):129-35. doi: 10.1007/s40259-018-0262-9

6. Nafar M, Samavat S, Khoshdel A, Alipour-Abedi B. Anemia Evaluation and Erythropoietin Dose Requirement Among Hemodialysis Patients: a Multicenter Study. Iran J Kidney Dis 2017;11(1):56-65. PMID: 28174354.

7. Mimran A. Renal effects of antihypertensive agents in parenchimal renal disease and renovascular hypertension. J Cardiovasc Pharmacol 1992; 19(suppl 6): 45-50. doi: 10.1097/00005344-199219006-00009.

8. Veys N, Dhondt A, Lameire N. Pain at the injection site of subcutaneously administered erythropoietin: phosphate-buffered epoetin alpha compared to citrate-buffered epoetin alpha and epoetin beta. Clin Nephrol 1998; 49(1):41-4.

9. Weiss LG, Clyne N, Divino Fihlho J, Frisenette-Fich C, Kurkus J, Svensson B. The efficacy of once weekly compared with two or three times weekly subcutaneous epoetin beta: results from a randomized controlled multicentre trial. Swedish Study G*roup. Nephrol Dial Transplant 2000; 15(12):2014-9. doi: 10.1093/ndt/15.12.2014.

10. Locatelli F, Andrulli S, Memoli B, Maffei C, Del Vecchio L, Aterini S, et al. Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients. Nephrol Dial Transplant 2006; 21(4):991-8. doi: 10.1093/ndt/gfk011

11. Besarab A, Reyes CM, Hornberger J. Meta-analysis of subcutaneous versus intravenous epoetin in maintenance treatment of anemia in hemodialysis patients. Am J Kidney Dis 2002; 40(3):439-46. doi: 10.1053/ajkd.2002.34881

12. Goldsmith D and O' Donoghue D. Optimizing hemoglobin control with erythropoesis-stimulating agent: results of the Subcutaneus Erythropoetin Control (SEC) study. Presented at ASN Philadelphia, USA; 2005.

13. Ebben JP, Gilbertson DT, Foley RN, Collins AJ. Hemoglobin level variability: associations with comorbidity, intercurrent events, and hospitalizations. Clin J Am Soc Nephrol 2006; 1(6):1205-10. doi: 10.2215/CJN.01110306

14. KDOQI. Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis 2006; 47(5 Suppl 3):16-85. doi: 10.1053/j.ajkd.2006.03.011.

15. Petković N, Ristić S, Stošović M, Đukanović L. Razlike u odgovoru bolesnika lečenih hemodijalizama na humani rekombinovani eritropoetin. Medicinski pregled 2013; 66(3-4):130-7. doi: 10.2298/MPNS1304130P

16. Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al. CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006; 355(20):2071-84. doi: 10.1056/NEJMoa062276

17. Ifudu O, Feldmann J, Friedman EA. The intensity of haemodialysis and the response to erythropoietin in patients with end-stage renal disease. N Engl J Med 1996; 334:420-5. doi: 10.1056/NEJM199602153340702

18. Sowade B, Sowade O, Mocks J, Franke W, Warnke H. The safety of treatment with recombinant human erythropoeitin in clinical use: a review-controlled studies. Int J Med 1998; 1: 303-14. doi: 10.3892/ijmm.1.2.303.

19. Choukroun G. Pain at the injection site: Results of the first cross-over study comparing epoetin beta and darbepoetin alfa administered subcutaneously in healthy volunteers. Presented at XLII ERA-ADTA congress, Istambul, Turkey; 2005.

20. Schmitt CP, Nau B, Brummer C, Rosenkranz J, Schaefer F. Increased injection pain with darbepoetin-alpha compared to epoetin-beta in paediatric dialysis patients. Nephrol Dial Transplant 2006; 21(12):3520-4. doi: 10.1093/ndt/gfl479

21. Stosevic M. Uporedna analiza indeksa adekvatnosti dijalize upotrebom kliničkih parametara pri raznim nivoima dijaliziranosti kod bolesnika na hemodijalizi. Doktorska disertacija, Medicinski fakultet Univerziteta u Beogradu; 2002.

22. Djukanovic L, Lezaic V. Liječenje anemije kod bolesnika sa hroničnom insuficijencijom bubrega rekombinantnim eritropoetinom. Srp arh 1996; 124:93-7.

23. Ratković M. Procjena kvaliteta liječenja bolesnika sa terminalnom bubrežnom insuficijencijom hemodijalizama. Doktorska disertacija, Medicinski fakultet Univerziteta u Beogradu; 2002.

24. Valderrabano F. Quality of life benefits of early anaemia treatment. Nephrol Dial Transplant 2000; 15(Supll 3):23-8. doi: 10.1093/oxfordjournals.ndt.a027972

25. Priyadarshi A, Shapiro JI. Erythropoietin resistance in the treatment of the anemia of chronic renal failure. Semin Dial 2006; 19(4):273-8. doi: 10.1111/j.1525-139X.2006.00172.x

26. El-Kannishy GM, Megahed AF, Tawfik MM, El-Said G, Zakaria RT, Mohamed NA, et al. Obesity may be erythropoietin dose-saving in hemodialysis patients. Kidney Res Clin Pract 2018; 37(2):148-56. doi: 10.23876/j.krcp.2018.37.2.148.

27. Kramer HJ, Saranathan A, Luke A, Durazo-Arvizu RA, Guichan C, Hou S, Cooper R. Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol 2006; 17:1453–9. doi: 10.1681/ASN.2005111241. 

28. Lorenzo V, Martin M, Rufino M, Sanchez E, Jiménez A, Hernández D, Torres A. High prevalence of overweight in a stable Spanish hemodialysis population: a cross sectional study. J Ren Nutr 2003; 13:52–9. doi: 10.1053/jren.2003.50004. 

 

Published
2022/10/09
Section
ORIGINAL ARTICLE