ACTA FAC MED NAISS 2019;36(1):05-14

Review article

UDC: 616.61-78:616.155.194-085.357

DOI: 10.2478/afmnai-2019-0001

Erythropoethin Resistance in Hemodialysis Patients

Saša Jacović¹, Milena Jovanović², Nedim Hamzagić³, Radiša Pavlović², Dejan Petrović^2,4

¹Medicines and Medical Devices Agency of Serbia, Belgrade, Serbia
²Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
³Center of Hemodialysis, Medical Center Tutin, Tutin, Serbia
⁴Clinic for Urology, Nephrology and Dialysis, Clinical center Kragujevac, Kragujevac, Serbia

summary


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 individualization 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.

Key words: anemia, erythropoietin resistance, hemodialysis, microinflammation, vitamin D deficiency