Nephrol Dial Transplant (2001) 16: 25-28
© 2001 European Renal Association-European Dialysis and Transplant Association
Hyporesponsiveness to recombinant human erythropoietin
INSERM Research Unit 507, Necker Hospital, Paris, France
Abstract
The introduction of recombinant human erythropoietin (rh-Epo, epoetin) as a treatment for the anaemia of renal failure has transformed the management of this condition. Nevertheless, a significant number of patients fail to respond. There are many different possible causes of inadequate response to epoetin. Iron deficiency, whether absolute or functional, is considered to be the most important, and it is widely accepted that maintaining adequate iron levels reduces rh-Epo dosage requirement and improves efficacy in haemodialysis patients. Infection and inflammation have been shown to influence responsiveness to rh-Epo by disrupting iron metabolism and eliciting the release of cytokines that inhibit erythropoiesis. Another factor for consideration is severe hyperparathyroidism, which can lead to a reduced number of responsive erythroid progenitor cells. Inadequate dialysis can also negatively impact on rh-Epo therapy, and aluminium overload interferes with iron metabolism and reduces the efficacy of rh-Epo. Deficiencies in vitamin B12, folic acid and potentially vitamin C can all reduce the efficacy of treatment with rh-Epo. Optimizing patient response to rh-Epo therapy, therefore, requires consideration of many factors, some well established and others that are more controversial, and the list continues to grow with the identification of new factors.
Keywords: anaemia; dialysis; epoetin; hypoparathyroidism; hyporesponsiveness; iron deficiency
Notes
Correspondence and offprint requests to: Dr Tilman Drüeke, Hôpital Necker, INSERM Unit 507, 161 Rue de Sevres, F-75743, Paris Cedex 15, France.
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