Parvovirus B19 (B19) and cytomegalovirus (CMV) infections and anti-erythropoietin (anti-EPO) antibodies in patients on dialysis hyporesponsive to erythropoietin therapy

Approximately 10% of patients receiving recombinant human erythropoietin (rHuEPO) do not respond to the treatment. We evaluated parvovirus B19 (B19) and cytomegalovirus (CMV) infections and anti-erythropoietin (anti-EPO) antibodies as potential causes of anemia in dialyzed patients, hyporesponsive t...

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Bibliographic Details
Published in:	Clinica chimica acta Vol. 431; pp. 52 - 57
Main Authors:	Alves, Michelle Teodoro, Vilaça, Sandra Simone, Godoi, Lara Carvalho, Júnior, Leonides Rezende, Carvalho, Maria das Graças, Silva, Franciele de Souza, Guimarães, Flávia Loli, Fernandes, Ana Paula, Dusse, Luci Maria SantAna, Gomes, Karina Braga
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 20-04-2014
Subjects:	Adult Aged Anemia Anti-erythropoietin antibodies Antibodies, Neutralizing - analysis Antiviral Agents - therapeutic use Case-Control Studies Cytomegalovirus Cytomegalovirus Infections - complications Cytomegalovirus Infections - immunology Dialyzed patients Drug Resistance, Viral Epoetin Alfa Erythema Infectiosum - complications Erythema Infectiosum - immunology Erythropoietin - immunology Erythropoietin - therapeutic use Female Humans Male Middle Aged Parvovirus B19 Parvovirus B19, Human Recombinant Proteins - therapeutic use Red-Cell Aplasia, Pure - complications Red-Cell Aplasia, Pure - immunology Renal Dialysis rHuEPO Anti-erythropoietin antibodies Cytomegalovirus PRCA Anemia anti-EPO Parvovirus B19 B19 CMV Dialyzed patients
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Summary:	Approximately 10% of patients receiving recombinant human erythropoietin (rHuEPO) do not respond to the treatment. We evaluated parvovirus B19 (B19) and cytomegalovirus (CMV) infections and anti-erythropoietin (anti-EPO) antibodies as potential causes of anemia in dialyzed patients, hyporesponsive to rHuEPO. Data from 120 dialyzed patients, receiving rHuEPO alfa, were collected: demographic characteristics, rHuEPO dose, duration of rHuEPO treatment and time on dialysis, etiology of chronic kidney disease and transfusion history. Serology and PCR were performed to address B19 and CMV infection status. An ELISA was developed to detect anti-EPO antibodies. rHuEPO resistance correlated with high ferritin levels (p=0.001) and short time on dialysis (p=0.012). B19 DNA was found in 10 (8.3%) dialyzed patients and CMV DNA was detected in 33 (27.5%). There was no significant correlation between B19 infection and anemia, while a tendency of correlation between active CMV infection and hemoglobin levels or hematocrit value (p=0.069 and p=0.070, respectively) has been observed. Anti-EPO antibodies were not detected in any patient. B19 infection is a rare complication in dialyzed patients and should be investigated after exclusion of other common causes, while CMV infection is rather common. The role of CMV infection in the hyporesponsiveness in dialyzed patients should be further evaluated in other studies. Our data suggest that anti-EPO antibodies are not involved in rHuEPO resistance in this population. •B19 is not the main cause of rHuEPO resistance.•rHuEPO resistance correlated with short time on dialysis.•CMV infection may be associated with hyporesponsive to rHuEPO treatment.•Anti-EPO antibodies seem to be not involved in the pathogenesis of anemia.
ISSN:	0009-8981 1873-3492
DOI:	10.1016/j.cca.2014.01.039