Evaluation of bone marrow findings in hemodialysis patients with erythropoietin resistant anemia

Introduction: In chronic kidney disease (CKD), anemia is a common cause of morbidity and mortality. Although there are many causes of anemia in CKD, the most important underlying pathology is relative erythropoietin deficiency. According to Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines, erythropoiesis-stimulating agents (ESA) are recommended after iron replacement therapy to provide a hemoglobin level of 10-11.5 g/dl. However, ESA resistance is an important problem. The aim of the study is to investigate the changes of bone marrow in hemodialysis patients with ESA resistant anemia. Material/ Method: Medical records of 210 CKD patients who were on hemodialysis between January 2012- March 2020, were evaluated retrospectively. The patients who were under optimal ESA therapy and had ESA resistance according to KDIGO guidelines were evaluated for the patient, disease characteristics, and bone marrow analysis. The patients were divided into subgroups according to the presence of dysplasia and hematological disease and survival analysis were performed. Results: The data of 26 patients were analyzed. The median age of the patients was 60 (25- 90). 17 (65.4%) of them were male and the median duration of hemodialysis treatment was 27.5 months (12- 102). The median hemoglobin level was 9.10 g / dl (6.6- 9.9), and the median ferritin value was 1103.5 ng/ml (235- 3633). Bone marrow iron overload was detected in 26.9% of bone marrow samples, and bone marrow fibrosis was found in 26.9%. Dysplasia was detected in 10 patients (38.5%) and 5 of them were diagnosed with hematological disease. The survival analysis revealed that the patients with a hematological pathology had poor survival outcomes (p = 0.045). Discussion: The early detection of bone marrow pathologies/hematological diseases and close follow up and treatment of them may provide better survival outcomes. Keywords: Hemodialysis, ESA resistance, bone marrow findings, anemia