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Resistance to recombinant human erythropoietin due to aluminium overload and its reversal by low dose desferrioxamine therapy.
  1. M. Yaqoob,
  2. R. Ahmad,
  3. P. McClelland,
  4. K. A. Shivakumar,
  5. D. F. Sallomi,
  6. I. H. Fahal,
  7. N. B. Roberts,
  8. T. Helliwell
  1. Department of Renal Medicine, Royal Liverpool University Hospital, UK.

    Abstract

    Seventeen severely anaemic and transfusion-dependent haemodialysis patients with a haemoglobin less than 7 g/dl were treated with recombinant human erythropoietin (r-Hu-EPO). Aluminium toxicity was diagnosed by a positive desferrioxamine (DFO) test and bone biopsy. Seven out of eight patients without aluminium toxicity responded to r-Hu-EPO therapy. Similarly all patients with aluminium toxicity (n = 4) but pre-treated with standard dose of DFO prior to r-Hu-EPO therapy responded but none of the patients with untreated aluminium toxicity (n = 5) responded to r-Hu-EPO therapy. In order to achieve adequate response in these patients, r-Hu-EPO and DFO had to be given in combination. The dose of desferrioxamine used to reverse r-Hu-EPO resistance was less and also used for a short time. We therefore confirm r-Hu-EPO resistance owing to aluminium overload and report its successful and safe reversal with low dose DFO therapy.

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