K KEEPPALLIL 1, S MANIKANTAN 1, E RAMPRASAD 1, M JAYAKUMAR 1
1Sri Ramachandra Institute Of Higher Education And Research, Chennai, India
Aim: To estimate the prevalence and determine the various causes of Erythropoesis Stimulatory Agents (ESA) resistant anemia in maintenance haemodialysis patient
Background: The most prevalent cause of renal anemia is decreased production of erythropoietin (EPO). Although the standard of care for the treatment of the renal anemia is EPO, some causes lead to inadequate response to EPO.
Methods: This was a prospective study done on all the haemodialysis patients in our dialysis unit from October 2020 to January 2021. A total of 262 patients on maintenance hemodialysis were included in the study. Among the anemic patients, basic investigations were done for evaluation of anemia. People who were found to be Iron deficient were given Iron supplements accordingly and rechecked after 3 months. People who were anemic despite treatment and receiving Erythropoetin injection atleast twice weekly were identified and evaluated.
Results: Among the 262 dialysis patients, 176 (67.17%) patients were found to be anaemic and a total of 158 (60.3%) anemic patients were found to be Iron deficient. Other causes of anemia included hyperparathyroidism in 14 patients (5.3%), Vitamin B12 deficiency in 3 patients (1.1%) and folic acid deficiency in 1 patient (0.3%). Among the 176 patients, 93% received injected human recombinant erythropoietin. 46 patients (17.5%) continued to have anemia and all these patients were getting recombinant Erythropoetin twice or thrice weekly. Significant proportion of patients were found to have poor nutritional status (36.67 %) and inadequate dialysis (25.83%).
Conclusion: This study showed that the prevalence of ESA resistant anemia was 17.5% and reiterates the importance of thoroughly investigating for the various causes of ESA resistant anemia and adequate management.
Nephrology Resident at Sri Ramachandra Institute of Higher Education and Research