Efeitos da pentoxifilina na anemia resistente à eritropoetina em pacientes sob hemodiálise
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Data
2008
Autores
Antunes, Sandra Azevedo [UNIFESP]
Orientadores
Gabriel Júnior, Alexandre [UNIFESP]
Tipo
Dissertação de mestrado
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Resumo
A anemia na Insuficiência Renal Crônica deve-se à redução da produção de eritropoetina, devido à diminuição da massa renal funcionante. A eritropoetina tem sido preconizada para o tratamento da anemia, no entanto, cerca de 5% dos pacientes são resistentes à mesma. A resistência à eritropoetina é definida como a necessidade do uso de uma dose maior que 12.000U/Kg por semana, sem atingir o hematócrito alvo de 33 a 36%. As citocinas pró-inflamatórias têm uma associação importante com a anemia resistente ao tratamento com
eritropoetina(EPO). A pentoxifilina tem sido usada para inibir a produção dessas citocinas pró-inflamatórias. Este estudo foi realizado com os pacientes sob hemodiálise no Instituto de Nefrologia Ribamar Vaz, do Hospital da Santa Casa de Misericórdia de Maceió-AL. Os pacientes com diagnóstico de resistência à eritropoetina receberam pentoxifilina na dose de 400mg VO, após hemodiálise por seis meses. Avaliamos o hematócrito e a proteína C reativa (PCR) em 2 momentos: ao final de três meses com 12 pacientes e, ao final de seis meses, com 7 pacientes. A média de PCR dos 12 pacientes, no primeiro mês, foi de 5,65mg/l. No terceiro mês, de 2,58mg/l. Porém, no sexto mês, considerando apenas os 7 que terminaram o projeto, foi de 4,55mg/l. Não foi observada diferença significativa. A média final dos hematócritos(Htc) observada nos pacientes foi de 28,74 %. A média dos Htc na avaliação de seis meses que precederam o início do projeto, foi de 26,22%. Não foi observada diferença estatisticamente significante, quer nos 12 pacientes acompanhados por três meses ou nos 7 que conseguiram concluir o estudo. Não observamos correlação entre os níveis de PCR e os de hematócrito. No entanto, em nossa
amostragem, a média de PCR basal não estava elevada e este pode ter sido um fator importante nos resultados díspares em relação aos dados da literatura. Sendo assim, concluímos que, em nossa amostra, não obtivemos benefícios com o uso da pentoxifilina. Porém, certamente se fazem necessários estudos mais amplos e controlados para que se possa chegar a conclusões que norteiem a indicação clínica desta droga como coadjuvante da EPO.
Anemia in End Stage Renal Disease occurs due to the reduction in the production of erythropoietin, caused by the decrease of the remaining renal mass. Erythropoietin has been indicated for the treatment of anemia; however, about 5% of the patients are resistant to it. Erythropoietin resistance makes it necessary to increase the dosage to more than 12000U/Kg/ per week, but without reaching the hematocrit target which should remain between 33 to 36%. The pro-inflammatory cytokines have an important association with the anemia resistant to erythropoietin treatment. Pentoxifylline has been used to inhibit the production of these pro-inflammatory cytokines. This study was carried out with patients on hemodialysis at the Ribamar Vaz Institute of Nephrology – at the Santa Casa de Misericórdia Hospital of Maceió. The patients with diagnosis of resistance to erythropoietin received pentoxifylline in the dosage of 400mg VO, after hemodialysis for six months. The hematocrit and protein C reactive (PCR) were analyzed twice: first at the end of three months with 12 patients and later at the end of six months, with 7 patients. The PCR average of the 12 patients in the first month was 5.65. In the third month it was 2.58. However, in the sixth month, just considering the 7 that finished the project, it was 4.55. No significant differences were observed. The final average of hematocrits observed in the patients was 28.74%. The HTC average, in the six-months evaluation that preceded the project, was 26.22%. No statistically-relevant differences were observed neither in the 12 patients followed for 3 months, nor in the 7 that had concluded the study. No correlations between the levels of PCR and HTC were observed. However, in our sampling, the average of basal PCR was not high and this might have been an important factor to explain the difference between our results and current literature. Therefore, we have concluded there were no benefits with the use of pentoxifylline. However, further studies, more comprehensive and accurate, are necessary in order to investigate the use of this drug as a support to EPO.
Anemia in End Stage Renal Disease occurs due to the reduction in the production of erythropoietin, caused by the decrease of the remaining renal mass. Erythropoietin has been indicated for the treatment of anemia; however, about 5% of the patients are resistant to it. Erythropoietin resistance makes it necessary to increase the dosage to more than 12000U/Kg/ per week, but without reaching the hematocrit target which should remain between 33 to 36%. The pro-inflammatory cytokines have an important association with the anemia resistant to erythropoietin treatment. Pentoxifylline has been used to inhibit the production of these pro-inflammatory cytokines. This study was carried out with patients on hemodialysis at the Ribamar Vaz Institute of Nephrology – at the Santa Casa de Misericórdia Hospital of Maceió. The patients with diagnosis of resistance to erythropoietin received pentoxifylline in the dosage of 400mg VO, after hemodialysis for six months. The hematocrit and protein C reactive (PCR) were analyzed twice: first at the end of three months with 12 patients and later at the end of six months, with 7 patients. The PCR average of the 12 patients in the first month was 5.65. In the third month it was 2.58. However, in the sixth month, just considering the 7 that finished the project, it was 4.55. No significant differences were observed. The final average of hematocrits observed in the patients was 28.74%. The HTC average, in the six-months evaluation that preceded the project, was 26.22%. No statistically-relevant differences were observed neither in the 12 patients followed for 3 months, nor in the 7 that had concluded the study. No correlations between the levels of PCR and HTC were observed. However, in our sampling, the average of basal PCR was not high and this might have been an important factor to explain the difference between our results and current literature. Therefore, we have concluded there were no benefits with the use of pentoxifylline. However, further studies, more comprehensive and accurate, are necessary in order to investigate the use of this drug as a support to EPO.
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Citação
ANTUNES, Sandra Azevedo . Efeitos da pentoxifilina na anemia resistente a eritropoetina em pacientes sob hemodialise. 2008. 61 f. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2008.