Speaker
Description
Erythropoietin (EPO)is a glycoprotein hormone which is mainly secreted by the kidney peritubalar cell when there is low blood oxygen level. It helps in RBC production.
EPO has been successfully used for over a decade to treat anemia in patients with chronic kidney disease. But up to 10% of patients receiving EPO are hyporesponsive to therapy and require large doses of the agent.The prevalence of chronic kidney disease (CKD) has increased in recent years and several risk factors have been associated with the onset and progression of CKD, such as obesity, hypertension and diabetes mellitus. In addition, anemia is one of the most important complications of CKD. The main causes of anemia are deficient production of erythropoietin (EPO), iron deficiency, and chronic disease with endogenous EPO resistance.
Several mechanisms could explain resistance to endogenous and exogenous EPO. Iron deficiency, deficiency of other nutrients, toxins, infections, and inadequate dialysis account for the vast majority of episodes of such resistance. Proinflammatory cytokines antagonize the action of EPO by exerting an inhibitory effect on erythroid progenitor cells and by disrupting iron metabolism (a process in which hepcidin has a central role).
There are various strategies to treat epo resistance like using iron therapy, ESA adjuvant, ascorbic acid, statins, carnitine. some newer clinical appproaches could be benefical .Gene therapy , Roxadustat, pentoxyfylline has given good responses.