(A-128) Prevalence And Factors of Erythropoietin Hyporesponsiveness in Chronic Kidney Disease Patients Undergoing Hemodialysis At A Public Sector Tertiary Care Teaching Hospital in Kerala: A Cross-Sectional Study

Background: Chronic kidney disease (CKD) is a prevalent non-communicable condition associated with high morbidity and mortality rates. Anemia is a common and severe hematological complication in patients with CKD and is primarily caused by reduced kidney function and irregular iron homeostasis. Erythropoietin (EPO) hyporesponsiveness or resistance is characterized by failure to attain the desired hemoglobin (Hb) level despite the administration of an elevated dose of EPO-stimulating agents (ESAs).

Objectives: This study aimed to assess EPO response in CKD patients undergoing dialysis at a tertiary care teaching hospital in Kerala and identify the factors contributing to EPO hyporesponsiveness.

Methods: A cross-sectional observational design was used, and 95 CKD patients with anemia (age≥18 years) taking EPO and undergoing hemodialysis in a tertiary care hospital were included. Hb level, complete blood count, ferritin concentration, transferrin saturation (TSAT), C-reactive protein (CRP), serum parathyroid hormone (PTH), liver function, calcium, and phosphorous levels were assessed. The chi-square test was used for the statistical analysis of categorical variables.

Results: The prevalence of EPO hyporesponsiveness was 36.8%. Gender showed a significant association with EPO hyporesponsiveness (p=0.001), with females more prone than males. Low ferritin and TSAT levels are linked to EPO hyporesponsiveness in CKD patients, which is crucial for red blood cell production. High PTH levels were noted in EPO hyporesponsive patients, suggesting a connection with parathyroid function. Elevated CRP levels may diminish EPO response due to inflammation. Angiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) could lower EPO responsiveness in CKD patients on hemodialysis. Low albumin, malnutrition, and inflammation correlate with EPO hyporesponsiveness.

Conclusions: This study identified factors like iron deficiency, inflammation, hyperparathyroidism, and age/gender influences contributing to EPO hyporesponsiveness in CKD patients on hemodialysis.