الفهرس 
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Abstract
Anemia is a common complication in hemodialysis (HD)
patients, mainly due to the insufficient production of erythropoietin
(EPO) by the failing kidneys .Anemia can worsens cardiac function,
cognitive function, exercise capacity, quality of life, and it also has been
associated with increased mortality and progression of renal disease
(Jose et al., 2013).
The introduction of erythropoietin stimulating agents (ESA)
therapy to treat anemia of chronic kidney disease (CKD) patients
improves patients’ quality of life. However, 5-10% of patients develop
resistance to ESA therapy (Gaweda et al., 2010).
The KDOQI guideline describes erythropoiesis stimulating
agents resistance as a low hemoglobin (Hb) level for the administered
erythropoiesis stimulating agents dose, which includes patients who fail
to achieve the target Hb of 11 g/dL while treated with high doses of
erythropoiesis stimulating agents (KDOQI, 2006). Erythropoiesis
stimulating agent’s resistance has been also associated with a 1.4- to a
more than 2-fold increased mortality rate (Marit et al., 2013).
Factors associated with ESA resistance and enhance need for
higher doses of erythropoiesis stimulating agents include iron deficiency,
chronic hyperparathyroidism, low serum albumin level, elevated
aluminum level, malnutrition, suboptimal dialysis and medications,
including angiotensin-converting enzyme inhibitors (Salman et al.,
2012).
The aim of the present work is to study the validity of
different clinical and laboratory parameters to predict erythropoietin
hyporesponsiveness in chronic hemodialysis patients.
To achieve this target, we performed this cross sectional study
on ninety seven (97) ESRD patients maintained on regular hemodialysis
attending Menoufia university Hospital and Mansheit Sultan
hemodialysis units during the period from December 2017 to December
2018.
Patients (n=97) were classified according to the achievement of
the target Hb (10-12 gm/dl) into two main groups; group A: patients
within the target Hb (Hb ≥ 10 gm/dl) (n=45) and group B: patients below
the target Hb (HB <10 gm/dl) (n=52). Patients were furtherly classified
according to anemia (Hb< 10 g/dL) and ESA hyporesponsiveness index
(EHRI ≥ 10) into four groups; group I: Non-anemic and ESA responsive
(n=41), group II: Non-anemic and ESA hyporesponsive (n=4), group III:
Anemic and ESA responsive (n=29) and group IV: Anemic and ESA
hyporesponsive (n=23).
In this study, all ESRD patients regularly undergo thrice-weekly
hemodialysis for 4 hours per session for more than 3 months. A variety of
factors were involved in the selection process. These included patient’s
demographic data, clinical and laboratory findings, past medical
histories. This was done to cover most of the suspected variables which
may have a role in the development of erythropoietin hyporesponsiveness
in ESRD patients.
Patients groups were compared regarding demographic, clinical,
laboratory data and EHRI.
In total 97 patients were enrolled in this study, 23 (23.7%)
patients are considered to have erythropoietin resistance (Hb < 10 gm/dl & ERI ≥ 10).