Predicting Resistance to Recombinant Human Erythropoietin Therapy in CKD Patients on Maintenance Hemodialysis

Mohanad Yasir Al-Radeef, Sajida Hussein Ismail, Ali Abdul-Majid Dyab Allawi

Abstract: Background Anemia is a common complication associated with chronic kidney disease (CKD), and optimal treatment requires appropriate diagnosis, recombinant human erythropoietin (rHuEPO) and iron therapy, and close monitoring of response. Approximately 5-10 % of these patients receiving rHuEPO therapy, however, appear to be hypo-responsive to this drug. This study aimed to identify some determinants of rHuEPO hypo-responsiveness in anemic CKD patients on maintenance hemodialysis. Method Seventy patients with CKD on maintenance hemodialysis receiving rHuEPO and (20) control subjects were enrolled in this case-control prospective study. Erythropoietin resistance index (ERI), calculated as the weekly weight-adjusted dose of rHuEPO divided by the hemoglobin level was determined to evaluate the doseresponse effect of rHuEPO therapy. Determinants of rHuEPO hypo-responsiveness were identified by univariate logistic regression analyses. Results Approximately half of patients were inadequately responded to rHuEPO therapy with an ERI value >0.0365 g/kg/week/g hemoglobin. Univariate analyses revealed that duration of dialysis (years), BMI and serum albumin were the most important determinants of rHuEPO hypo-responsiveness and an inverse relationship had been found between these determinants and ERI. Conclusion easily available clinical parameters and routine laboratory parameters can predict hypo-responsiveness to rHuEPO therapy in hemodialysis patients.

Keywords: CKD, Anemia, rHuEPO hypo-responsiveness, ERI