Response to recombinant human erythropoietin (rhEPO) is varied. Some patients will have excellent hematocrit values on small to moderate doses, while others may be significantly hyporesponsive. A need for >300 IU/kg/wk of rhEPO defines an inadequate response. The most common cause of inadequate response to rhEPO therapy is absolute or functional iron deficiency; but aluminum overload, infection and sepsis, chronic disease and inflammation, hyperparathyroidism, inadequate dialysis, and drug interactions can also cause rhEPO resistance. In dialysis patients, hemoglobinopathy is another very important factor with regard to rhEPO hyporesponsiveness. On the basis of available evidence, in thalassemia minor there is the necessity to employ higher rhEPO doses than in uremic controls - doses greater than the 300 IU/kg/wk cited as the definition of rhEPO hyporesponsiveness by much of the world's clinical practice guidelines. In end-stage renal disease patients with sickle cell disease, however, the hemoglobin should not be increased above 6-9 g/dl in order to avoid painful crises.
|Number of pages||5|
|Journal||Dialysis and Transplantation|
|Publication status||Published - 2001|
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