Renal anemili hemodiyaliz hastalarında eritropoietin ve intravenöz demir tedavisinin birlikte başlanmasının etkinliği
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Date
2007
Authors
Kar, Göksel
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Rekombinat human eritropoietin (EPO) kronik böbrek yetmezlikli hastalarda anemiyi etkili bir şekilde düzeltmekle birlikte pahalı bir tedavidir. EPO'ya yetersiz cevabın ve eritropoiezin artırılamamasının en sık nedeni demir eksikliğidir. Oral demir tedavisi EPO ile tedavi edilen kronik böbrek yetmezlikli hastalarında genellikle yeterli degildir. ntravenöz (iv) demir tedavisi yeterli hemoglobin yanıtı ve EPO dozunda azalma saglar. Biz bu çalısmayı, demir açıgı olan hemodiyaliz hastalarında iv demir ve EPO tedavisinin birlikte baslanmasının etkinligini ve maliyet üzerine etkisini arastırmak amacıyla yaptık. Çalısmaya 30 stabil hemodiyaliz hastası dahil edildi.30 hastadan 17'sine (Grup-I) rHuEPO (50 U/kg, haftada 2/3 kez her diyaliz sonrası) ve iv demir sukroz (100 mg, 1 ay süre ile haftada 3 kez, daha sonra ferritin düzeylerine göre devam edildi) baslandı. Diger hastalara (Grup-II) aynı dozda yalnız EPO verildi. EPO dozu hedef hematokrit (30-32%) degerine ulasabilmek için laboratuar sonuçlarına göre aylık olarak gerekiyorsa değiştirildi. Hemoglobin, hematokrit, kırmızı küre degerlerine tedavinin 3. ve 6 aylarında bakıldı. Sonuç olarak; iv demirin EPO ile birlikte uygulandığında hem aneminin etkin bir şekilde düzeldiğini hem de tedavi maliyetini azalttığı sonucuna vardık.
Recombinant human erythropoietin (rHuEPO) is a highly effective but expansive treatment for anemia in patients with chronic renal failure. The commonest cause of a poor response to EPO is the lack of an adequate supply of iron to meet the demands of enhanced erytropoiesis.Oral iron supplementation is usually inadequate in EPOtreated dialysis patients.Intravenosus iron therapy can improve the hemoglobin response with a reduction in EPO dose. We have performed this study in order to examine the efficiency of applying iv iron and EPO treatment together on the hemodialysis patients who have inadequate iron, and to investigate the effect of it on the cost. 30 stable hemodialysis patients were included in the study.17 out of 30 (Group-I) were given recombinant human EPO therapy (50 U/kg, sc, twice of three times weekly post dialysis session) plus iv ferric iron sucrose (100 mg, three times weekly for a month then weekly administration according to serum ferritin levels).The rest of patient (Group-II) were only given EPO using the same protocol.Monthly alerations were made in EPO dose to achieve target hematocrite values (30-32%).Hemoglobin, hematocrite and red blood cell values were measured pre, at 3nd and 6th month treatment. In conclusion, iv iron administration as well as EPO both improves anemia and decreases cost of treatment.
Recombinant human erythropoietin (rHuEPO) is a highly effective but expansive treatment for anemia in patients with chronic renal failure. The commonest cause of a poor response to EPO is the lack of an adequate supply of iron to meet the demands of enhanced erytropoiesis.Oral iron supplementation is usually inadequate in EPOtreated dialysis patients.Intravenosus iron therapy can improve the hemoglobin response with a reduction in EPO dose. We have performed this study in order to examine the efficiency of applying iv iron and EPO treatment together on the hemodialysis patients who have inadequate iron, and to investigate the effect of it on the cost. 30 stable hemodialysis patients were included in the study.17 out of 30 (Group-I) were given recombinant human EPO therapy (50 U/kg, sc, twice of three times weekly post dialysis session) plus iv ferric iron sucrose (100 mg, three times weekly for a month then weekly administration according to serum ferritin levels).The rest of patient (Group-II) were only given EPO using the same protocol.Monthly alerations were made in EPO dose to achieve target hematocrite values (30-32%).Hemoglobin, hematocrite and red blood cell values were measured pre, at 3nd and 6th month treatment. In conclusion, iv iron administration as well as EPO both improves anemia and decreases cost of treatment.
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Keywords
Hemodiyaliz, Demir tedavisi, rHuEPO tedavisi, Demir eksikliği, Maliyet, Hemodialysis, Iron treatment, rHuEPO treatment, Iron deficiency, Cost
Citation
Kar, G. (2007). Renal anemili hemodiyaliz hastalarında eritropoietin ve intravenöz demir tedavisinin birlikte başlanmasının etkinliği. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.