Improved Iron Utilization and Reduced Erythropoietin Resistance by On-Line Hemodiafiltration

Abstract

Background: Recent investigation has shown that on-line hemodiafiltration (HDF) can reduce the amount of recombinant human erythropoietin (rhEPO) deemed necessary to reach the target hematocrit. The aim of this study was to analyze the potential effect of on-line HDF on rhEPO resistance in relation to iron utilization and anemia-related parameters, when compared to conventional hemodialysis (HD). Methods: Ninety-two chronic uremic patients were treated with conventional HD and then shifted to on-line HDF. Measurements of various erythropoiesis-related parameters were collected during HD and on-line HDF periods for statistical analysis for erythropoietin resistance. Results: Patients treated with on-line HDF switching from conventional HD significantly contributed to the reduction of EPO dose to reach a higher mean hematocrit level (31.8 ± 4.4% vs. 29.5 ± 3.9%, p < 0.001) and a reduction of the serum ferritin level (322.5 ± 268.4 vs. 544.9 ± 642.4, p < 0.001). The median EPO/Hct ratio was greater in the HD period (504.6 ± 310.1) than in the on-line HDF period (307.6 ± 334.4) (p < 0.001). These results indicated a reduced EPO resistance and improved iron utilization by on-line HDF. By multiple regression analysis, the significant predictors of EPO resistance are ferritin, transferrin, albumin, and TACurea (Time average concentration of urea) in HD treatment. In on-line HDF modality, in addition to ferritin and albumin, the duration of on-line HDF is a negative predictor in EPO resistance. Conclusion: When on-line HDF is recommended to chronic dialysis patients, long-term use of this technique provides an efficient means of achieving the goal of an elevated hemoglobulin by reducing EPO resistance, improved iron utilization and may further improve the quality of life.

Greater Epoetin alfa Responsiveness Is Associated With Improved Survival in Hemodialysis Patients

“…For each subject, the quartile of erythropoietin response was plotted by the increase in Epoetin alfa dose at randomization (denominator of the response measure) on the horizontal axis, and hematocrit response (numerator of the response measure, which was the hematocrit slope derived from a simple linear regression of study week on hematocrit) on the vertical axis. ocrit values assessed at one point in time, including current Epoetin alfa dose (20), a ratio of Epoetin alfa dose to body weight (21), Epoetin alfa dose within levels of achieved hematocrit (19), current hematocrit (18), and average hematocrit over a specific time period (22).…”

Impact of Hemodialysis Therapy on Anemia of Chronic Kidney Disease: The Potential Mechanisms

“…Compared to standard dialysis, OL-HDF has been shown to improve the anemic status of CKD patients by significantly increasing Hb to target levels at reduced maintenance doses of EPO [26]. Two further studies showed that when patients are switched from conventional HD to OL-HDF, significantly higher hematocrit (Hct) and Hb levels were reached with the OL-HDF treatment modality [27,28 ](table 1). Attainment of higher Hct and Hb levels with more efficient dialysis therapies (HF membranes and convective therapies) has been attributed to the elimination of larger uremic retention substances that impair erythropoiesis [21,26].…”

“…Switching patients from conventional HD to OL-HDF was associated with a reduction in EPO dose to reach a higher mean Hct level [27,28]. In a study in which patients on conventional HDF were changed to OL-HDF, an EPO dose reduction of 16% EPO was observed after the switch to OL-HDF, with significant increase in Hb and Hct levels during the OL-HDF period [26].…”

Online Hemodiafiltration: Clinical Results and Economic Evaluation

“…По данным C. Lin с соавт. и F. Maduell с соавт., достоверное по-вышение уровня гематокрита при значимом сниже-нии дозы эритропоэтина отмечалось после перево-да пациентов с СТГД на ОЛ-ГДФ [27,28].…”