Abstract
Background: A definite anemia [hemoglobin (HB) 10-12 g/dl] or the need for significantly higher Erythropoietin (EPO) dosages of epoetin alfa are symptoms of EPO resistance, respectively. The recommended restorative goal is to maintain HB levels between 11 and 12 g/dl. Fe deficiency, concurrent inflammation, inadequate dialysis, hyperparathyroidism, hemolysis, vitamin B12, and folate deficiency are the main causes of EPO resistance. The objective of this study was to evaluate patients who receive frequent hemodialysis for EPO resistance.
Methods: This study was performed at Sohag University Hospital on 50 hemodialysis patients compared to 40 healthy adult subjects from June 2021 to January 2022. Serum EPO was analyzed by enzyme-linked immunosorbent assay and Angiotensin Converting Enzyme (ACE) rs1799752 polymorphism was assessed using the Genomic TaqMan genotyping test.
Results: This study found insignificant relation between EPO Resistance Index (ERI) and diverse ACE genotype groups and para thyroid hormone. A further significant direct proportional relationship was found between ERI and Ferritin. EPO and parathyroid hormone did not show any significant relationship.
Conclusion: Considering the non-critical connection between ERI and our components, it is vital to enhance the treatment of anemic patients with chronic kidney diseases to recognize the potential causes of resistance and ponder other variables for resistance before proposing an expanded EPO-stimulating agent administration.

Key words: Erythropoietin, hemodialysis, erythropoietin resistance index, erythropoietin stimulating agents.