Analysis of Initial Resistance of Erythropoiesis to Treatment with Recombinant Human Erythropoietin

The Response to Recombinant Human Erythropoietin in Patients with the Anemia of End-Stage Renal Disease Is Correlated with Serum Carnitine Levels

“…The anemia of end-stage renal disease (ESRD) has a multifactorial origin [1], This is reflected by large varia tions in the dose of recombinant human erythropoietin (rhEPO) needed to treat patients with this disorder [2][3][4][5]. Apart from blood loss and hemolysis, rhEPO therapy may be impaired by inflammation [5], insufficient body iron stores or transferrin saturation [5][6][7], and aluminium toxicity [4], Theoretically, hyperparathyreoidea might cause a reduced response to rhEPO, but so far, this has not been shown to be of clinical importance.…”

“…Apart from blood loss and hemolysis, rhEPO therapy may be impaired by inflammation [5], insufficient body iron stores or transferrin saturation [5][6][7], and aluminium toxicity [4], Theoretically, hyperparathyreoidea might cause a reduced response to rhEPO, but so far, this has not been shown to be of clinical importance.…”

Circulating Burst-Forming-Unit Erythroid and the Responsiveness to Recombinant Human Erythropoietin in Patients on Regular Hemodialytic Treatment

“…Although the therapy with r-HuEpo is highly effective, the heterogeneity of the clinical response in uremic patients is well known [22]. Equal starting doses of r-HuEpo can induce a brisk increase in hematocrit in some patients with an important risk of development of hyperten sion but can also be not effective in other patients [1][2][3].…”

Poor response to erythropoietin

“…As most patients with renal anaemia respond to 75-150 U/kg/week any such patient showing a rise in haemoglobin concentration of less than 10 g/l/month despite a dose of greater than 200 U/kg/week may be classed as a “poor responder.” Several factors may be responsible: important causes include iron deficiency,2 3 blood loss,4 infection, and inflammatory conditions, including malignancy 5 6. Other causes include hyperparathyroidism with marrow fibrosis,7 aluminium toxicity,8 vitamin B-12 or folate deficiency,9 haemolysis,10 marrow dysfunction,11 red cell enzyme defects, and haemoglobinopathies 12 13…”