[Importance of high C-reactive protein in patients with chronic renal disease]

An elevated serum C reactive protein [CRP] has been shown to be strongly predictive of morbidity and mortality in dialysis patients. However, little information is available regarding CRP levels in predialysis renal failure. The aim of our study was, determine the significance of high CRP levels in pre dialysis patients. In a cross- sectional study 100 pre dialysis patients were studied. The CRP levels, nutritional data [body mass index [BMI], serum albumin, cholestrol, triglycerides], hematocrit [HCT], hemoglobin [Hb], serum creatinine, creatinine clearance, urinary protein levels and blood pressure were measured and compared between patients with high [>6mg/l] or low [<6mg/l] CRP levels. In 100 chronic pre dialysis patients mean age was 48/8 +/- 12/8 years. CRP was greater than 6mg/l in 35%. We found some satistical relationship between high serum CRP levels and BMI, creatinine clearance, serum Albumin, serum cholestrol and high blood pressure. The prevalence of inflammation is high in predialysis patients. As occurs in dialysis patients, predialysis inflammation predicts morbidity in pre dialysis stage but further investigation should be done in this regard

Refractory anemia after epoetin therapy in patients with chronic renal failure

Anemia is the most frequent complication of chronic renal failure. Epoetin therapy reveals to be an effective therapy; however, development of anti-erythropoietin antibodies has been reported. The present study was conducted to determine the etiology of refractory anemia after Epoetin therapy in patients with chronic renal failure. All adult patients [530 patients] who had been prescribed regular hemodialysis and rHUEPO for at least three months were followed in seven hemodialysis units in Tehran. During a 6- month period, Venofer-Eprex dose and hemoglobin was recorded monthly. Having ruled out hemolysis and iron deficiently state in severe anemic patients, bone marrow examination was ordered. Of 530 patients, 58% were men with median age of 59 years. About%80 of patients had received baseline dose of at least 4000 units Eprex per week, prescribed subcutaneously after hemodialysis. Approximately, 21% were not anemic, while 19% did suffer from severe anemia [Hb<8]. There were statistically significant associations between severity of anemia and age [p<0.001], longer Epoetin therapy [p<0.001], co-treatment with Venofer [p<0.011] and lack of underlying disease [p<0.04]. Bone marrow aspiration was performed for 30 patients and the most frequent findings were anemia due to chronic disease, bone marrow dysplasia, amd megaloblastic anemia. In case of poor response to Epoetin therapy, discontinuing the drug is strongly recommended. Bone marrow examination is an appropriate tool to find the cause of refractoriness to Epoetin therapy in hemodialysis patients