Korean Journal of Nephrology 1996;15(2):164-175.

rHuEPO에 부적절한 반응을 보이는 만성 신부전성 빈혈에 대한 Desferrioxamine의 효과

도준영 , 강호정 , 박종원 , 임상우 , 이경희 , 윤경우 , 이현우

Abstract

Because refractoriness to rHuEPO treatment is a very urgent problem in patients receiving dialysis treatment, it is imperative that a better method for improving rHuEPO effectiveness should be establi- shed as soon as possible. DFO is chelating agent which is used in the treatment of aluminum related bone disease or severe aluminum induced microcytic anemia. This study is conducted to ten anemic patients having chronic renal failure. They are selected among sixty anemic patients under recombinant human erythropoietin treatment for at least six months in the internal medicine department of Yeungnam University Hospital. The patients in the sample have relatively low remedial value under rHuEPO treatment. After selecting ten low-respon- sive anemic patients to rHuEPO, DFO was administered for 8 weeks along with rHuEPO (the rHuEPO individual mean dosage had been deter- mined during the previous 6 months. The total mean dosage was 116.7U/kg/week.) After 8 weeks of DFO administration, the hemoglobin and rHuEPO dosage levels were checked for 4 consecutive months. It should be noted that the patients determined their own rHuEPO dosage levels according to hemoglobin levels and economic status. The results are as follows' 1) According to serum aluminum concentration (33.8±21.3ng/ml) and the DFO infusion test(48.0- 27.9ng/ml), the patient group showed minimal alumi- num accumulation. 2) Hemoglobin levels during DFO treatment were significantly higher than basal hemoglobin levels( 1st month' Hb=8.7±0.8g/dL,2nd month: Hb=9.4±1.1g/dL, basal Hb=7.7±0.7g/dL) 3) After DFO treatment, the hemoglobin level was significantly higher compared to the basal(8.7 g/dL vs 7.7 g/dL) and the rHuEPO dosage level was significantly reduced compared to the basal level (68U/kg/week vs 116U/kg/week). 4) The increment of hemoglobin concentration in the low ferritin group(<1000ng/ml) was higher than that of the high ferritin group with the same rHuEPO dosage (p<0.05). In conclusion, after the use of DFO, erythropoiesis was enhanced with a reduced rHuEPO dosage which enhances the disturbance of erythropoiesis. There- fore, it is important to prevent the accumulation of aluminium. The DFO can improve the anernia caused by chronic renal failure, and hence, can reduce the nurnber of doses of rHuEPO so that it lightens the economic burden of the patients. Additional studies in order to determine the mechanism of DFO on erythropoiesis and careful attention to potential side effects of DFO are needed.