Details
Category: Volume 08 Issue 08 August 2020
Hits: 896

Title: Is Тhere a Difference in the Resistance to Erythropoietin Stimulating Agents in Dialysis Patients Depending on Whether or not they Received such Treatment Before Starting Hemodialysis?

Author: Krasimira Atanasova Ashikova

 DOI: https://dx.doi.org/10.18535/jmscr/v8i8.36

Abstract

Background: The aim of the present study was to investigate a differences in the resistance to Erythropoietin Stimulating Agents (ESAs) in dialysis patients, depending on Whether or not they received such treatment before starting hemodialysis.

Material and Methods: This was a cross-sectional study from January 2009 to January 2020, 775 patients with end-stage kidney disease, on hemodialysis treatment (HDT). For a 12 years, the following categories were monitored by sex: age, hemoglobin levels, ESA dosage, Erythropoietin resistance index (ERI) in patients on periodic dialysis treatment in the Department of Dialysis Treatment /DDT/, UMHAT Sveta Anna Sofia. The following methods were used: Questionnaire; Hemoglobin test; ERI calculation by formula; Statistical methods–methods of prospective follow-up, Data analysis–t-Test: Two-Sample Assuming Unequal Variances, Descriptive and deductive statistics, Parametric analysis.

Results: 1.A very large number of patients have initiated hemodialysis treatment in emergency, without knowing about their disease and were not monitored by a nephrologist and were not treated with ESAs before dialysis. 2.There is a statistically significant difference in the mean hemoglobin level in women who were ESA treatment-naïve before HD compared to men who were ESA treatment-naïve before HD (p=0.047006), 3.There is a difference in terms of resistance- Erythropoietin Resistance Index(ERI) in were ESA treatment-naïve before HD compared to men who were ESA treatment-naïve before HD (p=0.013).

Conclusion: It is necessary to expand the scope, follow-up and treatment in patients with nephrological diseases without waiting for the progression of the disease. When administering ESA, always take into account the sex of the patients and consider the specific characteristics of female patients.

Keywords: Hemoglobin, CKD, hemodialysis, anemia, Erythropoiesis-stimulating agents (ESAs), Erythropoietin resistance index (ERI).

References

  1. McClellan W, Aronoff SL, Bolton WK, et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin. 2004;20(9):1501-1510.
  2. Sarnak MJ, Tighiouart H, Manjunath G, et al. Anemia as a risk factor for cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol. 2002; 40(1):27-33.
  3. Astor BC, Coresh J, Heiss G, Pettitt D, Sarnak MJ. Kidney function and anemia as risk factors for coronary heart disease and mortality: the Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J. 2006;151(2):492-500.
  4. Penninx BW, Pahor M, Woodman RC, Guralnik JM. Anemia in old age is associated with increased mortality and hospitalization. J Gerontol A BiolSci Med Sci. 2006;61(5):474-479. ⁵Nissenson AR, Goodnough LT, Dubois RW. Anemia: not just an innocent bystander? Arch Intern Med. 2003;163(12): 1400-1404.
  5. Fishbane S. Recombinant human erythropoietin: has treatment reached its full potential? Semin Dial. 2006;19(1):1-4.
  6. Szczech LA, Barnhart HX, Inrig JK, et al. Secondary analysis of the CHOIR trial epoetin-alpha dose and achieved hemoglobin outcomes. Kidney Int. 2008;74(6):791-798.
  7. Solomon SD, Uno H, Lewis EF, et al; Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) Investigators. Erythropoietic response and outcomes in kidney disease and type 2 diabetes. N Engl J Med. 2010;363 (12): 1146-1155.
  8. Steven Fishbane, Daniel W. Ross, and Susana Hong Anemia in Non–Dialysis-Dependent CKD: To Treat or Not to Treat? American Journal of Kidney DiseasesVolume 73, Issue 3, March 2019, Pages 297-299
  9. Mila Liubomirova Anaemia in chronic kidney disease. Modern aspects of treatment. Sofia 2012
  10. Koulouridis I, Alfayez M, Trikalinos TA, Balk EM, Jaber BL Dose of erythropoiesis-stimulating agents and adverse outcomes in CKD: a metaregression analysis. Am J Kidney Dis. 2013 Jan; 61(1):44-56.
  11. Evans R. W., Rader B., Manninen D. L. (1990). The quality of life of hemodialysis recipients treated with recombinant human erythropoietin. Cooperative Multicenter EPO Clinical Trial Group.JAMA 1990 Feb 9; 263 825–830. 10.1001/jama.1990.03440060071035 [PubMed] [CrossRef] [Google Scholar]
  12. Parfrey P. S., Foley R. N., Wittreich B. H., Sullivan D. J., Zagari M. J., Frei D. (2005). Double-blind comparison of full and partial anemia correction in incident hemodialysis patients without symptomatic heart disease. Am. Soc. Nephrol. 2005;Jul; 16 2180–2189. 10.1681/ASN.2004121039 [PubMed] [CrossRef] [Google Scholar]
  13. Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, Scherhag A, CREATE Investigators. N Engl J Med. 2006 Nov 16; 355(20): 2071-84. [PubMed] [Ref list]
  14. Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, Reddan D, CHOIR Investigators Correction of anemia with epoetinalfa in chronic kidney disease.NEngl J Med. 2006 Nov 16; 355(20):2085-98. [PubMed] [Ref list]
  15. Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, Feyzi JM, Ivanovich P, Kewalramani R, Levey AS, Lewis EF, McGill JB, McMurray JJ, Parfrey P, Parving HH, Remuzzi G, Singh AK, Solomon SD, Toto R, TREAT Investigators. A trial of darbepoetinalfa in type 2 diabetes and chronic kidney disease. N Engl J Med. 2009 Nov 19; 361(21):2019-32.[PubMed] [Ref list]
  16. US Food and Drug Administration (2007a). FDA Advisory Committee Briefing Document. Joint Meeting of the Cardiovascular and Renal Drugs Advisory Committee and the Drug Safety Risk Management Committee.Silver Spring, MD: S. Food and Drug Administration. [Google Scholar] [Ref list]
  17. Matti Aapro, Pere Gascón, Kashyap Patel, George M. Rodgers, Selwyn Fung, Luiz H. Arantes, Jr.and Jay Wish Erythropoiesis-Stimulating Agents in the Management of Anemia in Chronic Kidney Disease or Cancer: A Historical Perspective Front Pharmacol. 2018; 9: 1498.Published online 2019 Jan 9.  doi: 3389/fphar.2018.01498 PMCID: PMC6333861 PMID: 30687083
  18. Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, et al. (2006) Correction of anemia with epoetinalfa in chronic kidney disease. N Engl J Med 355: 2085–2098.
  19. Kalantar-Zadeh K, McAllister CJ, Lehn RS, Lee GH, Nissenson AR, et al. (2003) Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients. Am J Kidney Dis 42: 761–773.
  20. Locatelli F, Andrulli S, Memoli B, Maffei C, Del VL, et al. (2006) Nutritional-inflammation status and resistance to erythropoietin therapy in haemodialysis patients. Susantitaphong P, Riella C, Jaber BL (2013) Effect of ultrapure dialysate on markers of inflammation, oxidative stress, nutrition and anemia parameters: a meta-analysis. Nephrol Dial Transplant 28: 438–446.
  21. Lee CT, Chou FF, Chang HW, Hsu YH, Lee WC, et al. (2003) Effects of parathyroidectomy on iron homeostasis and erythropoiesis in hemodialysis patients with severe hyperparathyroidism. Blood Purif 21: 369–375.
  22. Movilli E, Cancarini GC, Zani R, Camerini C, Sandrini M, et al. (2001) Adequacy of dialysis reduces the doses of recombinant erythropoietin independently from the use of biocompatible membranes in haemodialysis patients. Nephrol Dial Transplant 16: 111–114.
  23. US Renal Data System Annul Report, Volume 2,2014
  24. Daniel W. Coyne, David Goldsmith, Ilian C. Macdougall New options for the anemia of chronic kidney disease Kidney Int Suppl (2011).2017 Dec;7(3:157-163 Published online 2017 Nov17. doi:10.1016/j.kisu.2017.09.002.

Corresponding Author

Krasimira Atanasova Ashikova

Department of Dialysis Treatment, Sveta Anna Hospital AD Sofia Bulgaria

Address: Sofia 1 Dimitar Mollov str.