Responsiveness of Recombinant Human Erythropoietin in Chronic Renal Failure Patients Undergoing Maintenance Hemodialysis / 대한신장학회잡지

BACKGROUND: Hyporesponsiveness to erythropoietin is an important issue in the treatment of the anemia of chronic renal failure. We tried to identify the factors of erythropoietin responsiveness in chronic renal failure patients undergoing maintenance hemodialysis for the effective treatment of anemia. METHODS: Seventy hemodialysis patients with hemoglobin increment over 2.0 g/dL during erythropoietin treatment were divided into two groups by median erythropoietin dose, 120 IU/kg/week (the low-dose group vs. the high-dose group). We compared age, gender, cause of renal failure, duration of hemodialyis, use of angiotensin-converting enzyme inhibitor, hemoglobin, hematocrit, serum iron, TIBC, transferrin saturation, ferritin, albumin, cholesterol, parathyroid hormone (iPTH), CRP, CO2 content, BUN, creatinine and Kt/V between the two groups. RESULTS: The low-dose group had significantly shorter duration of hemodialysis (40.9 months vs. 66.1 months, p=0.036), higher serum albumin level (3.93 g/dL vs. 3.72 g/dL, p=0.011) and lower iPTH level (94.97 pg/mL vs. 218.52 pg/mL, p=0.013) compared with the high-dose group. Serum creatinine level and Kt/V showed a tendency to be higher in the low-dose group but there were no significant differences (10.53 mg/dL vs. 9.40 mg/dL, p=0.053 and 1.69 vs. 1.38, p=0.080). Other clinical and laboratory parameters were not different between the two groups. CONCLUSION: Adequate nutritional support and prevention of secondary hyperparathyroidism may be helpful to enhance the responsiveness of erythropoietin in chronic renal failure patients undergoing maintenance hemodialysis.

Homocyst(e)ine and atherosclerosis in patients on chronic hemodialysis

Hyperhomocyst(e)inemia is an established risk factor for atherosclerosis. We performed this study to identify the correlating variables and risk factors for atherosclerosis, as measured by the atherosclerotic score (AS), and to determine the relative risk for cardiovascular disease in relation to plasma homocyst(e)ine levels in patients on chronic hemodialysis. We evaluated and measured 61 patients on chronic hemodialysis for clinical and biochemical parameters including atherosclerotic score (AS) and plasma homocyst(e)ine. We divided patients into high and low groups, first, by the mean AS, and second, by the median value of plasma total homocyst(e)ine levels. Then we compared the variables between the two groups. Out of the 61 patients, the median plasma total homocyst(e)ine level was 24.4 micromol/L (mean+/-SD, 27.7+/-17.4; range, 9.8-127.4 micromol/L), and the median AS was 5 (mean+/-SD, 6.2+/-2.8; range, 3-13) out of a possible 20 points. AS was significantly correlated with plasma total homocyst(e)ine levels (r=0.37) and age (r=0.67). Through multivariate analysis, plasma total homocyst(e)ine level and age were determined as significant risk factors for the high-AS group (p0.05). Eighteen of the 61 patients, presented with cardiovascular disease until the present study, had an AS>6. Cardiovascular disease was found more often in the high-homocyst(e)ine group (>24.4 micromol/L) than in the low-homocyst(e)ine group (odds ratio, 9.3; 95% confidence interval, 2.3-37.4). Regardless of age, hyperhomocyst(e)inemia (especially homocyst(e)ine levels >24.4 micromol/L) is a risk factor that can be modified for the development of cardiovascular disease in patients on chronic hemodialysis.