ABSTRACT
Background: Anemia is a constant feature of chronic renal failure patients. There are many causes for this anemia ranging from deficient erythropoietin production, iron deficiency, blood losses, to the effect of uremic toxins such as hyperparathyroid state, some inflammatory cytokines and aluminum toxicity. Inflammation is a common cause of severe anemia and inadequate response to recombinant erythropoietin (EPO) therapy in maintenance hemodialysis (HD) patients. Objectives: This study was performed to assess recently determined predictors for inflammation rictocetin platelet aggregation test (RIPA) and IgM. We also studied the link between early detection of inflammation and the response to EPO in pediatric patients. Methods: Twenty-eight children on regular HD, their age ranging from 1-16 years with stable general condition were included in this study. They were on EPO treatment and iron supplementation. Thorough clinical examination, routine laboratory work, CBC, CRP, Urea, serum creatinine, serum calcium, serum sodium and serum phosphorus were done. Parathormone level, IgM and platelet aggregation test wer also done for these patients. Results: There was a strong correlation between RIPA and Hb change in HD patients under EPO therapy. The mean level of RIPA was 71.7 ± 4.1% in the responder group. The activity in the non-responder group was Impaired with mean level 49 ± 6.6%. Also there was a strong correlation between RIPA and Hb changes. Increased Hb level is associated with better function of platelets (r = 0.4, p < 0.01). There is no significant correlation between IgM level and Hb changes in either group. Conclusions: A low grade chronic inflammatory state is an important determinant of anemia in clinically stable maintenance HD patients, The reasons for such impaired response to erythropoietin could be some micro-inflammatory effect of HD procedures and an inflammation induced platelet dysfunction of vascular endothelial cells.