Prevalence of Erythropoiesis Stimulating Agents Hyporesponsiveness in Dialysis Patients in Assiut University Hospital
Study Details
Study Description
Brief Summary
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The prevalence of erthropoietin stimulating agents hyporesponsiveness in hemodialysis patients in Assiut university hospital
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Assessment of cardiovascular diseases risk in patients with erythropoiesis stimulating agents hyporesponsiveness in hemodialysis patients in Assiut university hospital
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Detailed Description
Anemia is common in patients with chronic kidney disease. The routine use of erthropoietin in anemia control has reduced morbidity and mortality rates in patients with chronic kidney disease. Despite an increase in the use and average dose of recombinant human epoetin over the last 15 years, a substantial percentage of patients still don't achieve hemoglobin targets recommend by international guidelines. The definition of recombinant human epoetin resistance has been introduced to identify those patients in whom the target hemoglobin level is not attained despite a greater than usual dose of erthropoietin stimulating agent. In recent years, increasing attention has been paid to the relationship between dialysis, increased inflammatory stimulus, malnutrition, and erythropoiesis stimulating agents response. Erythropoiesis stimulating agents hyporesponsiveness was defined by the erythropoietin resistance index, which was the erythropoietin dose per week divided by body weight and Hemoglobin level . The resistance to erythropoiesis stimulating agents is directly related with incident comorbidity in patients on hemodialysis and it can be interpreted as a useful marker of early mortality. Patients with higher erythropoietin resistance index values had a higher all cause mortality rate and cardiovascular mortality rate. Erythropoietin resistance index was related with left ventricular mass index, left ventricle systolic function and cardiovascular events in patients with hemodialysis. By monitoring of erthropoietin resistance index, early identification of the epoetin resistance may be useful to predict the cardiovascular risk in hemodialysis patients
Study Design
Outcome Measures
Primary Outcome Measures
- Assessment of the prevalence of Erythropoiesis stimulating agents hyporesponsiveness in dialysis patients in Assiut university hospital [One year]
Erythropoiesis resistance index which is the erythropoietin dose per week divided by body weight and Hemoglobin level
Secondary Outcome Measures
- Assessment of cardiovascular diseases risk in hemodialysis patients with erythropoiesis stimulating agents hyporesponsiveness [One year]
Echocardiography
Eligibility Criteria
Criteria
Inclusion Criteria:
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age more than 18
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End stage renal disease patients undergoing regular hemodialysis in Assiut University Hospital - Hemodialysis unit for duration at least 3 months
Exclusion Criteria:
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acute infectious disease within one month
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active liver disease or cancer
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recent blood transfusion or surgical intervention
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active bleeding or hemorrhage
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Assiut University
Investigators
- Principal Investigator: Hewida Abdelhakem Nafady, Assiut University
- Study Director: Radwa Awad abdelhafez, Assiut University
Study Documents (Full-Text)
None provided.More Information
Publications
- Bamgbola OF, Kaskel FJ, Coco M. Analyses of age, gender and other risk factors of erythropoietin resistance in pediatric and adult dialysis cohorts. Pediatr Nephrol. 2009 Mar;24(3):571-9. doi: 10.1007/s00467-008-0954-3. Epub 2008 Sep 18.
- Chung S, Song HC, Shin SJ, Ihm SH, Park CS, Kim HY, Yang CW, Kim YS, Choi EJ, Kim YK. Relationship between erythropoietin resistance index and left ventricular mass and function and cardiovascular events in patients on chronic hemodialysis. Hemodial Int. 2012 Apr;16(2):181-7. doi: 10.1111/j.1542-4758.2011.00644.x.
- de Lurdes Agostinho Cabrita A, Pinho A, Malho A, Morgado E, Faisca M, Carrasqueira H, Silva AP, Neves PL. Risk factors for high erythropoiesis stimulating agent resistance index in pre-dialysis chronic kidney disease patients, stages 4 and 5. Int Urol Nephrol. 2011 Sep;43(3):835-40. doi: 10.1007/s11255-010-9805-9. Epub 2010 Jul 17.
- Del Vecchio L, Pozzoni P, Andrulli S, Locatelli F. Inflammation and resistance to treatment with recombinant human erythropoietin. J Ren Nutr. 2005 Jan;15(1):137-41. doi: 10.1053/j.jrn.2004.09.024.
- Lopez-Gomez JM, Portoles JM, Aljama P. Factors that condition the response to erythropoietin in patients on hemodialysis and their relation to mortality. Kidney Int Suppl. 2008 Dec;(111):S75-81. doi: 10.1038/ki.2008.523.
- Lu X, Zhang J, Wang S, Yu Q, Li H. High Erythropoiesis Resistance Index Is a Significant Predictor of Cardiovascular and All-Cause Mortality in Chinese Maintenance Hemodialysis Patients. Mediators Inflamm. 2020 Nov 26;2020:1027230. doi: 10.1155/2020/1027230. eCollection 2020.
- Okazaki M, Komatsu M, Kawaguchi H, Tsuchiya K, Nitta K. Erythropoietin resistance index and the all-cause mortality of chronic hemodialysis patients. Blood Purif. 2014;37(2):106-12. doi: 10.1159/000358215. Epub 2014 Mar 5.
- Tanaka S, Kitamura H, Tsuruya K, Kitazono T, Nakano T; FKR Study Collaboration Group. Prevalence, treatment status, and predictors of anemia and erythropoietin hyporesponsiveness in Japanese patients with non-dialysis-dependent chronic kidney disease: a cross-sectional study. Clin Exp Nephrol. 2022 Sep;26(9):867-879. doi: 10.1007/s10157-022-02227-8. Epub 2022 May 4.
- Erythropoietin resistance