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Erythropoietin hyporesponsiveness among egyptian hemodialysis patients

Salah Eldin Khedr PhD, Alaa E. Saad PhD, Mohamed M. Abdo PhD, Heba M. Zaki, Mohamed MSc.


Almost all ESRD patients on HD receive iron and EPO to treat anemia, however some patients do not respond sufficiently to the therapy. Response to EPO influenced by various factors, such as malnutrition, vitamin deficiencies, chronic blood loss, secondary hyperparathyroidism, chronic inflammation and decrease hepcidin excretion. This study included 80 anemic patients who had been on regular HD for more than 3 months. Patients received adequate doses of ESA and iron for 3 months, after that they were classified into two groups ESA responders and ESA hyporesponders. Laboratory investigations were done to assess some of risk factors which may lead to ESA hyporesponsiveness as Iron profile, IL-6, CRP, anti-EPO antibody, hepcidin level and PTH. Sixty percent of the patients were EPO hypo-responsive, ferritin has higher level in hypo-responders. Hepcidin and IL-6 markedly elevated among ESRD patients also were markedly elevated among hypo-responders. Hepcidin did not show any correlations with IL-6 or CRP but has strong correlation with ferritin. Prevalence of anti-EPO antibody was 7.5 % of total population. Parathyroid hormone had no statistically significant association with HB or reticulocytes. Hepcidin was higher among EPO-hyporesponders and had strong correlation with ferritin, so we can consider hepcidin as an important biomarker for iron stores utilization in anemic patients and to predict patient response to EPO therapy. Hepcidin did not show any correlations with IL-6 or CRP, so inflammatory mediators did not influence its high level, but mostly due to its retention in ESRD patients.

Key words: Erythropoietin hyporesponsiveness, hemodialysis patients, hepcidin

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