Efeitos da pentoxifilina na anemia resistente à eritropoetina em pacientes sob hemodiálise

A anemia na insuficiencia renal cronica deve-se a reducao da producao de eritropoetina, devido a diminuicao da massa renal funcionante. A eritropoetina tem sido preconizada para o tratamento da anemia, no entanto, cerca de 5 por cento dos pacientes sao resistentes a mesma. A resistencia a eritropoetina e definida como a necessidade do uso de uma dose maior que 12.000U/kg por semana, sem atingir o hematocrito alvo de 33 por cento a 36 por cento. As citocinas pro-inflamatorias tem uma associacao importante com a anemia resistente ao tratamento com eritropoetina (EPO). A pentoxifilina tem sido usada para inibir a producao dessas citocinas pro-inflamatorias. Este estudo foi realizado com os pacientes sob hemodialise no Instituto de Nefrologia Ribamar Vaz, do Hospital da Santa Casa de Misericordia de Maceio-Al. Os pacientes com diagnostico de resistencia a eritropoetina receberam pentoxifilina na dose de 400 mg VO, apos hemodialise por seis meses. Avaliamos o hematocrito e a proteina C reativa (PCR) em dois momentos: ao final de tres meses com 12 pacientes e, ao final de seis meses, com sete pacientes. A media de PCR dos 12 pacientes, no primeiro mes, foi de 5,65 mg/l. No terceiro mes, de 2,58 mg/l. Porem, no sexto mes, considerando apenas os sete que terminaram o projeto, foi de 4,55 mg/l. Nao foi observada diferenca significativa. A media final dos hematocritos(Htc) observada nos pacientes foi de 28,74 por cento. A media dos Htc na avaliacao de seis meses que precederam o inicio do projeto, foi de 26,22 por cento. Nao foi observada diferenca estatisticamente significante, quer nos 12 pacientes acompanhados por tres meses ou nos sete que conseguiram concluir o estudo. Nao observamos correlacao entre os niveis de PCR e os de hematocrito. No entanto, em nossa amostragem, a media de PCR basal nao estava elevada e este pode ter sido um fator importante nos resultados dispares em relacao aos dados da literatura. Sendo assim, concluimos que, em... Anemia in end stage renal disease occurs due to the reduction in the production of erythropoietin caused by the decrease in functional renal mass. Erythropoietin has been indicated in the treatment of anemia however, about 5 percent of patients are resistant to this treatment. In erythropoietin resistance, it is necessary to increase the dosage to more than 12000 U/Kg/weekly, but even so the hematocrit target, which should remain between 33 and 36 percent, is not reached. Pro-inflammatory cytokines are significantly associated to resistance to erythropoietin treatment and so pentoxifylline is used to inhibit the production of these pro-inflammatory cytokines. This study was carried out with hemodialysis patients at the Ribamar Vaz Institute of Nephrology - in the Santa Casa de Misericordia Hospital of Maceio. Patients with diagnoses of resistance to erythropoietin received 400mg VO pentoxifylline after hemodialysis over a period of six months. The hematocrit and C-reactive protein (CRP) concentrations were analyzed three times: in the first month, at the end of three months (12 patients) and at the end of six months (7 patients). The mean CRP of the 12 patients in the first month was 5.65 and in the third month it was 2.58. However, in the sixth month, with the 7 patients remaining in the protocol, it was 4.55. No significant differences were observed. The final average hematocrit concentration of the patients was 28.74 percent. The average hematocrit concentration, in the six-month evaluation that preceded the project, was 26.22 percent. Statistically-relevant differences were not observed in the 12 patients followed up for 3 months or in the 7 that concluded the study. No correlations between the levels of CRP and hematocrit concentration were observed. However, in our sampling, the mean basal CRP was not high and this might have been an important factor to explain the difference between our results and other published reports. Thus,...