Resistencia a la eritropoyetina en pacientes con anemia en hemodiálisis, algoritmo terapéutico
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2016
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Una de las manifestaciones más comunes de la Insuficiencia renal crónica (ERC) es la anemia, cuya causa principal es la deficiencia en la producción de Eritropoyetina (EPO). Existe una pequeña proporción de pacientes que no responden o lo hacen débilmente a su administración, categoría que puede ser calculada mediante el índice de resistencia a la EPO (IRE). El IRE es la relación entre la dosis semanal, el peso corporal en kilogramos y el valor de hemoglobina siendo de interés los valores por encima de 10. Existen múltiples factores que inciden en el aumento y que son importantes en su diagnóstico para una mejor terapéutica. Muchos estudios han revelado una fuerte relación entre mortalidad, supervivencia y resistencia a la EPO en pacientes en hemodiálisis. El presente estudio cualitativo tipo estudio de casos tiene como objetivo la elaboración de un algoritmo terapéutico para la resistencia a la Eritropoyetina. Se realizó un estudio en el Centro Nefrológico Acacias Guangala, durante el período de Julio a Diciembre del 2015, se seleccionó 50 pacientes que cumplieron con los criterios de inclusión y exclusión cuyos datos clínicos y de laboratorio se encontraron registrados. Se evidenció que las principales causas de resistencia en pacientes hiporespondedores fue el déficit de hierro, mala adecuación en diálisis, dosis no ajustada al peso de EPO, hiperparatiroidismo secundario, mal estado nutricional, uso de ARA y que existen factores no modificables que se relacionan a la insuficiente respuesta en el manejo de la anemia como el sexo femenino y pacientes mayores a 50 años. Un correcto diagnóstico y manejo de los factores causantes de un IRE alto ayudará a mejorar la supervivencia y morbilidad de pacientes en Hemodiálisis y a reducir costos del tratamiento.
One of the most common manifestations of chronic renal failure (CKD) is anemia, whose main cause is the deficiency in the production of Erythropoietin (EPO). There is a small proportion of patients who do not respond or do weakly to administration, a category that can be calculated using the rate of resistance EPO (IRE). The IRE is the relationship between the weekly dose, body weight in kilograms and hemoglobin values of interest being over 10. There are many factors affecting the increase and are important in diagnosis for better therapy. Many studies have shown a strong relationship between mortality, survival and resistance to EPO in hemodialysis patients. This qualitative study type case study aims at developing a therapeutic algorithm for Erythropoietin resistance. A study was conducted in the Nephrology Center Guangala Acacias, during the period from July to December 2015, 50 patients who met the inclusion and exclusion criteria whose clinical and laboratory data were found registered was selected. It was evident that the main causes of resistance in hiporespondedores patients was iron deficiency, poor dialysis adequacy, dose not adjusted to the weight of EPO, secondary hyperparathyroidism, poor nutritional status, use of ARA and that there are no modifiable factors related to insufficient response in the management of anemia as females and patients over 50 years. A correct diagnosis and management of the factors causing high IRE help improve survival and morbidity in hemodialysis patients and reduce treatment costs
One of the most common manifestations of chronic renal failure (CKD) is anemia, whose main cause is the deficiency in the production of Erythropoietin (EPO). There is a small proportion of patients who do not respond or do weakly to administration, a category that can be calculated using the rate of resistance EPO (IRE). The IRE is the relationship between the weekly dose, body weight in kilograms and hemoglobin values of interest being over 10. There are many factors affecting the increase and are important in diagnosis for better therapy. Many studies have shown a strong relationship between mortality, survival and resistance to EPO in hemodialysis patients. This qualitative study type case study aims at developing a therapeutic algorithm for Erythropoietin resistance. A study was conducted in the Nephrology Center Guangala Acacias, during the period from July to December 2015, 50 patients who met the inclusion and exclusion criteria whose clinical and laboratory data were found registered was selected. It was evident that the main causes of resistance in hiporespondedores patients was iron deficiency, poor dialysis adequacy, dose not adjusted to the weight of EPO, secondary hyperparathyroidism, poor nutritional status, use of ARA and that there are no modifiable factors related to insufficient response in the management of anemia as females and patients over 50 years. A correct diagnosis and management of the factors causing high IRE help improve survival and morbidity in hemodialysis patients and reduce treatment costs
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Anemia, Diálisis renal, Resistencia a la eritropoyetina, Centro Nefrológico Acacias Guangala, Cantón Guayaquil, Ecuador, Algoritmo terapéutico