Recombinant human erythropoietin (rhu-epo) responsiveness in chronic kidney disease (ckd) patients at the Kenyatta National Hospital Renal Unit.

Abstract

Background: In the Kenyan setup, unnecessary blood transfusion in chronic kidney disease patients on haemodialysis exposes them to risks that include iron overload; blood tranfusion related events and increased probability of future renal graft rejection due to alloimmunization. Objective: We set out to determine adequacy of response to Erythropoietin as given at the renal unit in KNH as per the NHIF coverage. Methods: This was a prospective study conducted at the renal unit in Kenyatta National Hospital over an 8 week period. The calculated sample size for this study was 15. Thirty eight (38) patients aged 18 years and above with confirmed CKD were recruited. Adequate Response to EPO was determined by an increase in haemoglobin of at least 1 g/dl every 4 weeks for the 8 weeks of follow-up. Results: Adequate response to EPO treatment was 39% at 4 and 8 weeks, with a mean EPO dosage of 4000 Units(44-88U/kg) a week at entry. The resulting haemoglobin change was from a mean of 7.9g/dl (SD1.1) at entry to 9.4g/dl (SD1.4) at week 8. At the same time, adequate response to EPO ranged from 29% to 60% for different weekly dosages of iron sucrose at different times of follow-up with the highest EPO response with 200 mg at 4 weeks. Adequate response at week 8 was higher for those with a mean ferritin level of 962 μg/l compared to those with a mean ferritin level of 532 μg/l (p-Val 0.033). Conclusion: The EPO response observed in this study at 39% is markedly lower than that quoted in other studies along with low doses administered, perhaps due to the constraints of NHIF provisions. Recommendation: Increasing EPO dosage with appropriate iron administration while remaining within safe doses with regard to cardiovascular safety is an option under a more expanded NHIF cover. The other alternative of maintaining the current regime and optimising vitamin D should be studied in our setup as has been demonstrated within Africa among other factors including adequacy of dialysis