Epoetin Alfa Resistance: Valuation of a Management Algorithm: RESULTS
From October 1 to December 31, 2000, 212 patients were screened and 21 (10%) patients with a hemoglobin concentration less than 110 g/L for 3 consecutive months were identified (Table 1). All identified patients were receiving epoetin alfa, a multiple vitamin preparation (Dia-Vite, R&D Laboratories, Marina Del Rey, California), and iron supplementation. The majority (62%, 13/21) of patients were receiving intravenous iron dextran.
With the use of the algorithm, the 21 patients identified were divided into 5 groups: (i) those for whom correction of their anemia was not their physician’s long-term goal (0%, 0/21 patients), (ii) those with dialysis inadequacy (24%, 5/21 patients), (iii) those who were noncompliant with their epoetin alfa regimen (0%, 0/21 patients), (iv) those with iron deficiency (48%, 10/21 patients), and (v) those with epoetin alfa resistance (38%, 8/21 patients). Many patients had more than one suspected cause of epoetin alfa nonresponse. canadian antibiotics
Table 1. Characteristics of 21 Patients Identified with a Hemoglobin Concentration Less Than 110 g/L for 3 Consecutive Months
Suspected epoetin alfa resistance in 8 patients was caused by one of the following: chronic infection (tuberculosis, calciphylaxis infected lesions, chronic osteomyelytis, or fungal peritonitis), chronic inflammation (chronic Wegener’s granulomatosis, pericarditis, systemic lupus erythematosus, or calciphylaxis), or hyperparathyroidism.
In most cases, a single intervention aimed at correcting anemia was made, and its effect on hemoglobin concentrations was evaluated for at least 1 month. However, patients receiving inadequate dialysis often had their dialysis regimen adjusted, coincident with another intervention aimed at improving their hemoglobin concentrations. Outcomes could not be determined for 5 of the 21 patients identified: 3 patients died, 1 patient received a kidney transplant, and 1 patient switched to peritoneal dialysis during the follow-up period. kamagra soft tablets
Table 2. Outcomes for 16 Patients Followed for 3 Months
Outcomes for the 16 patients who completed the follow-up period are listed in Table 2. Mean hemoglobin concentrations improved from baseline to the end of the follow-up period from 92.8 ± 11.0 to 106.9 ± 14.7 g/L (p = 0.0009).
The majority (11/16) of patients achieved a hemoglobin concentration greater than 110 g/L within the 3-month follow-up period. Nine of these 11 patients achieved a hemoglobin concentration of 110 g/L 1 month after they were identified. Both patients with inflammation (Wegener’s granulomatosis, calciphylaxis) were receiving active treatment before the study period and achieved their target hemoglobin without further intervention. Similarly, the patient with hyperparathyroidism was receiving treatment with intravenous calcitriol before the study period and achieved the target hemoglobin without additional treatment. Two further patients achieved the target hemoglobin during the follow-up period: one after problems with underdialysis, acute and chronic infection, and a low epoetin alfa dose were dealt with; the other after recovering from bleeding in the upper gastrointestinal tract. Cialis Jelly
The remaining 5 of the 16 patients did not achieve their target hemoglobin, despite increases in their epoetin alfa doses and administration of intravenous iron. The suspected reasons for their not achieving their target hemoglobin were chronic underdialysis (the patient’s choice), persistent pericarditis, active systemic lupus erythematosus, a low epoetin alfa dose, and an unknown cause. In the case of the patient who had epoetin alfa resistance of unknown cause, a hematologist recommended additional investigations (haptoglobin concentration, reticulocyte count, parvovirus serology) and an increase of the epoetin alfa dose beyond 300 IU kg-1 week-1. No other patient had the epoetin alfa dose increased beyond 300 IU kg-1 week-1.