4.5. Erythropoietin doses reduction

Anemia is an important cause of morbidity and mortality in chronic hemodialysis patients. Treatment with erythropoiesis-stimulating agents is influenced by many factors that can induce erythropoietin resistance, such as:


An imbalance between oxidant and antioxidant system in hemodialysis patients is well known. Any studies found low levels of superoxide dismutase and decreased activity of erythrocyte superoxide dismutase in erythrocyte membranes, leading to increased reactive oxygen species production, increased anemia, and resistance to erythropoietin treatment. Some authors found that vitamin E supplementation was followed by increased activity of erythrocyte superoxide dismutase, improving anemia and erythropoietin responsiveness in these patients [4, 10, 21].
