Erythropoietin Resistance in Hemodialysis Patients

• Main Authors: Jacović Saša, Jovanović Milena, Hamzagić Nedim, Pavlović Radiša, Petrović Dejan
• Format: Article
• Language: English
• Published: Sciendo 2019-03-01
• Series: Acta Facultatis Medicae Naissensis
• Subjects: anemia; erythropoietin resistance; hemodialysis; microinflammation; vitamin D deficiency
• Online Access: http://www.degruyter.com/view/j/afmnai.2019.36.issue-1/afmnai-2019-0001/afmnai-2019-0001.xml?format=INT

Anemia is defined as blood hemoglobin concentration of less than 120 g/l in women and less than 130 g/l in men. The main cause of the development of anemia in patients treated with regular hemodialysis is the lack of endogenous erythropoietin, and its main clinical consequences are: progressive decline in residual renal function, development of cardiovascular disorders, disorders of cognitive functions and a decrease in the quality of life of these patients. Despite the administration of an appropriate dose of erythropoietin, in 5-10% of patients treated with regular hemodialysis, there is resistance to erythropoietin activity. The main risk factors for the development of resistance to the effects of erythropoietin are: iron deficiency, microinflammation, deficiency of vitamin D, secondary hyperparathyroidism, deficiency of vitamin C, and inadequate hemodialysis. The main side effects of erythropoietin are: hypertension, thrombosis of the vascular approach to hemodialysis, and the red blood cell precursor aplasia in the bone marrow. Early detection and elimination of risk factors, optimization and indi-vidualization of hemodialysis prescription prevent the development of resistance to erythropoietin activity, enable the achievement of target blood hemoglobin, reduce the development of cardiovascular morbidity, and improve the quality of life of these patients.