Effect of Increased Hemodialysis Time on the Response to Erythropoietin in Patients with End-Stage Renal Disease

Background: A cost-effective use of epoetin requires that the maximum gain in hematocrit level be obtained for a given dose. If such could be achieved, it would justify the use of scarce health care resources for epoetin treatment.
Objectives: The aim of the work was to determine the effect of increase in the time of dialysis on the hematocrit in epoetin-treated hemodialysis patients.
Methods: We prospectively studied 60anemic patients undergoing bicarbonate hemodialysis with hemophan membranes for a follow-up duration of 12 weeks. Patients were randomized into 4 equal groups. Groups A & C were dialyzed for 4 hrs thrice weekly and groups B & D for 6 hrs thrice weekly. Group C& D Patients received a fixed dose of epoetin. We investigated the relationship between dialysis time, URR, and the percent change in hematocrit.
Results: With increase in dialysis time there was a highly statistically significant difference in mean URR in group B from 0.594 ± 0.03 to 0.722 ± 0.03 at the beginning and after 12 weeks respectively with % change of 20.5 (p ˂ 0.01) and group D from 0.596 ± 0.02 to 0.749 ± 0.03 with a % change 25.85 (p ˂ 0.01). There was a highly significant difference between groups in mean hematocrit at the beginning of the study (group D had the lowest value). The highest hematocrits were achieved in group B from a mean of 24.74 ± 5.07 to 31.09 ± 3.56 ± 3.23 to 32.13 ± 3.49 with a % change of 69.8 (p ˂ 0.01) while group A had the lowest level from 24.67 ± 3.78 to 25.46 ± 3.68 with a % change 4.2. There was a significant positive correlation between             URR and the change in hematocrit ( coefficient of correlation 0.44).
Conclusions: We conclude that dialysis time appears to be an important independent factor predicting response to epoetin. In a country with limited resources, where treatment expenses are first priority, we recommend that using epoetin, with its consequent impact on the cost of management, must be coupled with optimizing the dose of dialysis by increasing dialysis time.