| Background:First of all, erythropoietin (EPO) was found by Carnot et al in 1906, along with the development of gene technology, recombinant human erythropoietin (rHuEPO) begin its clinical application in 1986,and its in troduc- tion is considered one of the greatest progress in end-stage renal disease (ESRD) patients on dialysis for the treatment of anemia.It not only can correct the anemia in patients with end-stage uremia , but also improve their quality of life, work intensity and improve their ability to work, strengthen their body resistance, the occurrence of infection decreased and significantly prolonged survival time. The response to EPO varies among individual patients. According to the literature, approximately 90%-95% of renal anemia responded in a dose-dependent manner to EPO, whereas the remaining 5%-10% of patients had a blunted or no response to EPO, despite high-dose therapy. This is known as EPO hypo-responsiveness or EPO resistance.Various factors that have been reported to be related to this hypo-responsiveness, one of iron deficiency is the major factor, followed by infection / inflammation, malnutrition, secondary hyperparathyroidism, aluminum poisoning can cause EPO resistance. In addition, angiotensin-converting enzyme inhibitor (ACEI) and angiotensinⅡreceptor antagonist can also affect the curative effect of rHuEPO. At the United States, EPO resistance in patients has around 4%; European EPO resistance in patients has no more than 10%; Japan EPO resistance in hemodialysis patients accounted for 3.7%, peritoneal dialysis patients with EPO resistance accounted for 13.6%; in China, there is no precise reports.Objective:In this paper, the present study was aimed at investigating the factors such as C reactive protein, serum albumin, normalized protein catabolic rate (nPCR) and immunoreactive parathyroid hormone,to investigate factors that can predict EPO hypo-responsiveness or EPO resistance in a group of patients on maintenance hemodialysis dialysis (MHD).Material and Methods:A cohort of 37 patients taking regular hemodia- lysis between Jan. 2008 and Dec. 2008 in our center was studied. They all had been on hemodialysis for more than 3 months and on erythropoietin (EPO)≥100 U/kg per week for more than 3 months. We expressed EPO resistance index (ERI) as weekly EPO dose per hematocrit (Hct) per body weight. The dose of EPO was titrated to maintain a target Hct level between 33% and 36%. Patients were divided into two groups according to weekly EPO dose. We compared the various factors in those two groups and, by using correlation and linear regression analysis, investigated factors that might predict EPO resistance. Statistical analysis:SPSS 13. 0 was used. Comparison of the various factors among two groups were analyzed by t-test. The association of EPO resistance index and other indicators were analyzed by spearman correlation and multiple linear stepwise regression.Results:There were 22 patients in the EPO <150 U/kg per week group and 15 patients in the EPO≥150 U/kg per week group. Among those 15 patients, there were three patients on EPO≥300 U/kg per week. Compared to the EPO <150 U/kg per week group,the EPO≥150 U/kg per week group had a lower normalize- ed protein catabolic rate (nPCR), lower level of serum albumin and higher C-reactive protein (CRP). Correlation analysis showed that the ERI had a statistically significant correlation with CRP (r = 0.427, P < 0.01), serum albumin (r = - 0.356, P < 0.05), parathyroid hormone (PTH) (r = 0.318, P < 0.05) and nPCR (r =- 0.307, P < 0.05). These results show that CRP, serum albumin, PTH and nPCR are factors related to hypo-responsiveness.Multiple stepwise linear regression analysis showed that CRP was the most important independent predictor of EPO hypo-responsiveness.Conclusion:CRP, serum albumin, nPCR and PTH are factors related to hypo-responsiveness. There is a prevalence of microinflammatory state in the maintenance hemodialysis patients. The microinflammatory state is the most important predictor of the EPO resistance. |
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