EPO-Hyporesponse – Strategien für eine effektive Therapie

Die Anämie bei einer chronischen Funktionseinschränkung der Niere ist multifaktoriell bedingt. Der Erythropoetinmangel ist im Zentrum der Aufmerksamkeit und der Therapie. Man muss aber die begleitenden Faktoren berücksichtigen. Ansonsten ist die EPO-Therapie unwirksam. Häufig wird die renale Anämie von Eisenmangel, Eisenverwertungsstörungen bei akuten oder chronischen Entzündungszuständen, sekundärem Hyperparathyreoidismus und weiteren, seltenen Faktoren begleitet. Diese Komponenten muss man bei einem fehlenden Ansprechen der renalen Anämie auf EPO-Gaben analysieren. Eine EPO-Hyporesponse ist definiert als ein fehlendes Ansprechen über 4–6 Monate nach der Substitution von mehr als 300 IE EPO pro kg Körpergewicht pro Woche. Die Differenzialdiagnose der EPO-Hyporesponse und die Abklärung können schematisiert erfolgen. Unter einer danach erfolgenden gezielten Behandlung ist die Substitution im Regelfall effektiv.

The causes of anemia in chronic renal failure are multiple. The deficiency of erthyropoetine is in the centre of the awareness of the caregivers. However, the accompanying factors also have to be put into account. Otherwise, failure of EPO therapy is the result. Renal anemia often is combined with iron deficiencies, iron achrestic pictures seen with acute or chronic inflammations, secondary hyperparathyreoidism and more, rare factors. These components have to be analyzed if failure of EPO therapy is diagnosed. The definition of EPO hyporesponse is as following: not reaching target hemoglobin levels after the use of more than 300 IU EPO per kg bodyweight per week for 4–6 months. The work-up of the differential diagnosis can be following a flow-sheet. With target-aimed therapy, EPO becomes effective again.

Key words

erythropoetin - kidney - anemia - dialysis - iron deficiency - hyperparathyreoidism - infection - inflammation

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