Prevalence and risk factors of erythropoiesis stimulating agents hyporesponsiveness in chronic hemodialysis patients attending nephrology center of Benghazi

Abstract

Background: Anemia is quite prevalent in end stage renal disease patients. Despite availability of different forms of erythropoiesis stimulating agents, many end stage renal disease patients are anemic according to National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative guidelines. Patient and methods: we conduct a cross sectional study between May 2022 and July 2022, targeting adult chronic hemodialysis patients, to investigate the prevalence of erythropoiesis stimulating agents hyporesponsiveness, to assess if patients are receiving the appropriate weight-based dosing of these agents, and to identify additional risk factors behind inadequate response to therapy.390 end stage renal disease patients are receiving chronic hemodialysis at nephrology center of Benghazi. Incident hemodialysis patients, patients with other hematological disease or with malignancy are excluded. Finally, 150 patients met the inclusion criteria and enrolled in the study. Results: 100 (66.7%) are male, and 50 (33.3%) are females. Age is 50.6 ±13.2 years. Erythropoiesis stimulating agents hyporesponsiveness is prevalent in chronic hemodialysis patients, 130 (86.7%) patients are anemic as their Hb levels were <11 g/dl, while only 20 (13.3%) patients have Hb levels of >/=11g/dl. There is a significant relationship between gender and ESA response, as hyporesponsiveness is more observed in male patients (P < .005). We find that 105 (70%) patients are receiving an appropriate weight-based dose, while only 45 (30%) patients were giving an inappropriate dose. When the relationship between ESA dosing and patients' response to ESA is examined, we find, that despite receiving the appropriate dose, 90 (60%) patients are ESA hyporesponsive, while only 15 (10%) are responsive to the appropriate weight-based dose. However, no statistical association is found between ESA hyporesponsiveness and age or weekly hours of dialysis. Conclusion: despite receiving an appropriate dosage of ESA, our study population shows high prevalence of ESA hyporesponsive anemic state. New strategies should be applied to detect risk factors and adopt therapeutic measures to reduce its high prevalence in hemodialysis population.