The waveform fluctuation and the clinical factors of the initial and sustained erythropoietic response to continuous erythropoietin receptor activator in hemodialysis patients

Wen-Sheng Liu, Yueh-Lin Wu, Szu-Yuan Li, Wu-Chang Yang, Tzen-Wen Chen, Chih-Ching Lin, Wen-Sheng Liu, Yueh-Lin Wu, Szu-Yuan Li, Wu-Chang Yang, Tzen-Wen Chen, Chih-Ching Lin

Abstract

Objectives: Erythropoiesis-stimulating agents (ESA) are the main treatment for anemia in hemodialysis (HD) patients. We evaluated factors determining the response after treatment of a new ESA (continuous erythropoietin erythropoietin receptor activator (CERA)).

Methods: 61 HD patients were classified by their response at two different timings. First, patients whose hematocrit (Hct) increased 1.5% in the first week were defined as initial responders (IR, n = 16). We compared several parameters between IR and the rest of the study subjects (non-IR, n = 45). Second, patients whose Hct increased 2% in the 4th week were defined as sustained responders (SR, n = 12), and we did a similar comparison.

Results: The Hct showed a waveform fluctuation. Compared with the rest, IR had significantly lower platelet counts and higher levels of ferritin, total protein, total bilirubin, and serum sodium, while SR had significantly lower levels of C-reactive protein and low-density lipoprotein (All P < 0.05). In comparison with the rest, higher Hct persisted for 10 weeks in SR but only for two separate weeks (the 1st and 7th week) in IR.

Conclusions: The initial and sustained erythropoietic responses are independent from each other and are associated with different factors. Treatment focusing on these factors may improve the response.

Figures

Figure 1
Figure 1
The changes of hematocrit during the first 5 weeks after CERA use. The changes of hematocrit in 61 hemodialysis patients during the first 5 weeks. (The mean value and standard deviation of Hct of HD patients are displayed weekly.)
Figure 2
Figure 2
The Variation of hematocrit between IR and non-IR (a) and SR and non-SR (b). (a) Comparison of changes of Hematocrit after treatment of CERA between initial responders (IR) and the rest of the study group (non-IR), (b) similar comparison between sustained responders (SR) and the rest of the study group (non-SR). (The mean value and standard deviation of Hct of HD patients are displayed weekly.)

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Source: PubMed

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