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Submitted: 09 May 2016
Accepted: 17 Jul 2016
ePublished: 14 Aug 2016
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J Prev Epidemiol. 2016;1(2): e15-.
  Abstract View: 1550
  PDF Download: 1046

Original

Clinical and economic benefits of dialysate quality on anaemia control and erythropoietin responsiveness among chronic hemodialysis patients 

Omar Maoujoud 1,2*, Yahia Cherrah 1, Nadir Zemraoui 3, Ahmed Alayoud 2, Mohammed Asseraji 3, Mohammed Lisri 4, Driss Elkabbaj 5, Hocein Dkhissi 4, Oualim Zouhair 4, Samir Ahid 1

1 Research Team of Pharmacoepidemiology & Pharmacoeconomics, Medical and Pharmacy school, Mohammed V University, Rabat, Morocco
2 Department of Nephrology & dialysis, Military Hospital Agadir, Morocco
3 Department of Nephrology & dialysis, Military Hospital Marrakech, Morocco
4 Scientific Committee, Moroccan Society of Nephrology, Rabbat, Morocco
5 Department of Nephrology and Dialysis, Mohammed V Military Hospital Rabat, Morocco
*Corresponding Author: Correspondence to: Omar Maoujoud, Email: maoujoud@gmail.com

Abstract

Introduction: In chronic hemodialysis patients (CHP), micro-inflammation is an important contributor to hyporesponsivenness to erythropoiesis stimulating agents (ESA).

Objectives: The aim of this prospective and observational study was to evaluate the influence of ultrapure dialysate (UPD) on the evolution of ESA responsiveness, anaemia control and cost in CHP.

Patients and Methods: We screened CHP with renal anaemia, receiving adequate haemodialysis at our dialysis unit and on therapy with recombinant human epoetin beta (EpoB), for a followup during 1 year, after changing the water treatment and dialysate from conventional dialysate (<100 CFU/mL, endotoxins <0.25 EU/mL) to UPD (<0.1 CFU/ml, endotoxins <0.03 EU/mL). EpoB responsiveness was evaluated by the erythropoietin resistance index (ERI) and anaemia control and for secondary analysis by the change in EpoB cost throughout the study period.

Results: Forty-eight CHP were included. The ERI was significantly lower after conversion to UPD, mean ERI was 13.7 ± 1.9 UI/kg/wk/g/dL on conventional dialysate, decreased to 8.29 at 6 months (P = 0.01) and 8.46 UI/kg/wk/g/dL at one year. There was a significant increase in mean hemoglobin (Hb) at 6 months of follow up (12.07 ± 1.78 g/dl, P = 0.02) after conversion to UPD, and was maintained until the end of the study (11.1 ± 1.66 g/dL). Also the proportion of patients with Hb >11 g/dL increased from 17.8% at the beginning to 80.4% at month 6 (P = 0.011), and 78.5 % after 1 year.

Conclusion: UPD should be adopted as a basic component of modern dialysis procedures for improving clinical outcomes such as anaemia management and Epo responsiveness, and also for the economic benefits related to the decrease in Epo requirement. 


Citation: Maoujoud O, Cherrah Y, Zemraoui N, Alayoud A, Asseraji M, Lisri M, et al. Clinical and economic benefits of dialysate quality on anaemia control and erythropoietin responsiveness among chronic hemodialysis patients.  J Prev Epidemiol. 2016;1(2):e15.
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