Estudio de algunos factores que puedeninfluir en el tratamiento con eritropoyetinade la anemia en hemodiálisis

espanolLa eficacia de la accion de la eritropoyetina humana recombinante en el tra-tamiento de la anemia de los pacientes en dialisis esta limitada por algunos fac-tores. Presentamos un estudio prospectivo de 6 meses de duracion en 23 pacientesestables, tratados en hemodialisis mas de un ano, valorando si determinados pa-rametros modificaban la dosis de la hormona para obtener un hematocrito simi-lar. Se estudio: tratamiento o no con inhibidores de la enzima conversora de laangiotensina II, diagnostico o no de hepatopatia virus C, o enfermedad renal quis-tica adquirida, edad mayor o menor de 60 anos y sexo.Los pacientes estaban tratados con eritropoyetina via subcutanea, durante masde un ano, para alcanzar un hematocrito de 35%; con hierro via intravenosa paraconseguir niveles de ferritina plasmatica mayores de 250 ng/ml y un indice desaturacion de transferrina mayor del 20%, acido folico y vitaminas del grupo B.Parametros estudiados: edad, tiempo y duracion de la dialisis, KTV, albumina, he-matocrito, eritropoyetina en u/kg/semana, PTH intacta, virus C, PCR del virus C,transaminasas, ferritina, indice de saturacion de transferrina, a. folico, vit B12 yaluminio plasmatico.Los pacientes tratados con el antihipertensivo precisan dosis mayores de hor-mona que los no tratados (71 ± 25 vs 44 ± 25 u/kg/semana, p EnglishSeveral factors influence the efficacy of the action of human recombinanterythropoietin during treatment of anaemia in haemodialysis patients. We ca-rried out a six-month prospective study of 23 stable patients who had been onhaemodialysis for at least one year to attempt to evaluate those factors modif-ying the dose of the hormone to attain a similar haematocrit, such as use ornot of angiotensin converting enzyme inhibitors, hepatitis C virus positive or ne-gative, age older or younger than 60 years, acquired cystic kidney disease ornot, and sex. The patients were treated with subcutaneaous erythropoietin forover a year to attain a haematocrit of 35%, intravenous iron to reach plasmaferritin levels > 250 ng/ml and a transferrin saturation index > 20%, folic acidand group B vitamins.Parameters studied included age, time and duration of haemodialysis, Kt/V, al-bumin, haematocrit, erythropoietin in U/kg/week, intact PTH, hepatitis C virus,PCR of the hepatitis C virus, transaminases, ferritin, transferrin saturation index,folic acid, vitamin B12, and aluminium. No statistically significant differences wereseen between the patients with and without hepatitis or in age or acquired cys-tic kidney disease and sex in the hormone dose given to achieve similar levels ofhaematocrit. Higher doses of erythropoietin were necessary in those patients tre-ated with antihypertensive agents (71 ± 25 vs 44 ± 25 U/kg/week; p