Identifying and Treating Factors Associated With Erythropoietin Resistance

Patients with end-stage kidney disease with anemia are commonly treated with recombinant human erythropoietin. However, according to Juan Daniel Diaz Garcia and colleagues at Centro Medico Nacional 20 Noviembre, Mexico City, Mexico, various factors may contribute to possible resistance to this therapy.

The researchers conducted a prospective study to evaluate the impact of a structured team approach for the management of anemia in erythropoietin-resistant hemodialysis patients. Results were reported during a poster session at the American Society of Nephrology Kidney Week 2023 in a poster titled Risk Factors Involved in Erythropoietin Resistance in Patients With CKD in a Hemodialysis Unit.

During a study period of 18 months, 27 patients were identified as erythropoietin-resistant, defined as erythropoietin >300 units/kg/week. Hemoglobin level, iron indices, parathyroid hormone, and folate, vitamin B12, and reticulocyte counts were determined at baseline and during the study period at 6, 12, and 18 months. Target hemoglobin was 10 to 12 g/dL.

A specialized nephrology team evaluated potential factors associated with erythropoietin resistance, and, if necessary, treated every 4 weeks. If the underlying causes of resistance could not be identified or reversed, or if hemoglobin exceeded the target level, downward adjustments of erythropoietin dose of 12.5% to 25% to the nearest 1000 units were considered.

The predominant treatable factors associated with erythropoietin resistance were parathyroid hormone levels or iron deficiency. At 4 months, there was a significant decrease in mean erythropoietin dose, from 469 to 319 units/kg/week (P<.001). There was a significant increase in mean hemoglobin level from 10.6 g/dL to 11.6 g/dL (P=.023). At 8 months, patients had erythropoietin doses of less than 300 units/kg/week, reaching target hemoglobin levels.

In summary, the authors said, “A structured team approach of nephrologists and a monthly adaptation with an individualized management of the patient managed to significantly reduce the dose of erythropoietin with an improvement in serum hemoglobin reaching the objectives set in the international guidelines, identifying and solving the factors involved.”

Source: Diaz Garcia JD, Maldonado Tapia D, Morales Lopez F, et al. Risk factors involved in erythropoietin resistance in patients with CKD in a hemodialysis unit. TH-PO949. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania.