Monitoring and optimizing the dose response relationship of erythropoietin in haemodialysis patients

ABSTRACT

Renal disease is characterized by failure of erythropoietin production and low bone marrow sensitivity to erythropoietin. Renal anemia is repidly corrected by recombinant human erythropoietin therapy but the dose required varies greatly [Lind et al., 1997]. In this study, the erythropoietin doses required for the treatment of anemia of renal failure were monitored and optimized by using the recent flow cytometric reticulocyte analysis and testing the parameters of bone marrow response to different erythropoietin doses. This work was carried out on forty patients, with recent onset of haemodialysis for end stage renal disease without any history of previous erythropoietin therapy. After exclusion of common causes that may cause resistance to erythropoietin [EPO] therapy like iron deficiency, blood loss, hyperparathyroidism and aluminum toxicity, the patients were divided into two groups Group A and group B. Group A had 10 patients who received non-erythropoietin bone marrow stimulants in the from of anabolic steroids. And group B had 30 patients which were further subdivided into three subgroups I/II and III and received EPO therapy at a dose of 30, 40 and 50 I.U/Kg BW S.C. times/week respectively. All the patients were investigated by doing s. PTH, s. iron indices/ s. Aluminum, blood indices, uper endoscopy, stool analysis for occult blood and flow cytometric determination of RMI. Administration of non-erythropoietin bone marrow stimulants in the form of anabolic steroids in group A showed insignificant increase in Hb%/ reticulocyte maturity index [RMI] and absolute reticulocyte count [ARC]. EPO therapy in the doses of 30/ 40 and 50 I.V/Kg body weight thrice/week S.C [group B I/ II and III respectively] showed a significant increase in Hb% on the 2nd and 3rd month from the begining of the study. So, administration of recombinant human EPO in pharmacological quantities enabled a more efficient therapy of ESRD-induced anemia and significantly reducing the need for blood transfusion