Study of several factors influencing the treatment of dialysis-associated anaemia with erythropoietin

Several factors influence the efficacy of the action of human recombinant e rythropoietin during treatment of anaemia in haemodialysis patients. We car ried out a six-month prospective study of 23 stable patients who had been o n haemodialysis for at least one year to attempt to evaluate those factors modifying the dose of the hormone to attain a similar haematocrit, such as use or not of angiotensin converting enzyme inhibitors, hepatitis C virus p ositive or negative, age older or younger than 60 years, acquired cystic ki dney disease or not, and sex. The patients were treated with subcutaneaous erythropoietin for over a year to attain a haematocrit of 35%, intravenous iron to reach plasma ferritin levels > 250 ng/ml and a transferrin saturati on index > 20%, folic acid and group B vitamins. Parameters studied included age, time and duration of haemodialysis, Kt/V: albumin, haematocrit, erythropoietin in U/kg/week, intact PTH, hepatitis C virus, PCR of the hepatitis C virus, transaminases, ferritin, transferrin s aturation index, folic acid, vitamin B12, and aluminium. No statistically s ignificant differences were seen between the patients with and without hepa titis or in age or acquired cystic kidney disease and sex in the hormone do se given to achieve similar levels of haematocrit. Higher doses of erythrop oietin were necessary in those patients treated with antihypertensive agent s (71 +/- 25 vs 44 +/- 25 U/kg/week; p < 0,05). There were no differences b etween groups in factors known to cause resistance to the action of the hor mone. The most important conclusions from this study concern the cost-benefit rel ation of treating hypetensive patients on haemodialysis with angiotensin co nverting enzyme inhibitors and erythropoietin.