Nephrol Dial Transplant (2001) 16: 224-227
© 2001 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Inflammation, serum C-reactive protein, and erythropoietin resistance
Division of Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
Introduction
The anaemia associated with chronic renal failure has many causes. The main reason is deficient erythropoietin synthesis with serum levels of erythropoietin which are too low for the degree of anaemia. Blood loss, either iatrogenic from the puncture sites of the vascular access and blood sampling, or from other sources such as the gastrointestinal tract are contributive. As a result, iron requirements are often increased more than fivefold in dialysis patients. Most patients with chronic renal failure achieve the desired target haemoglobin (Hb) level when supplemented with relatively low doses (50–150 IU/kg/week) of recombinant human erythropoietin (epoetin) and parenteral iron (usually 1500–3000 mg/year) [1]. About a quarter of the dialysis patients, however, have a poor response and need higher doses (>200 IU/kg/week) to reach the target Hb level. This relative resistance to epoetin and iron is often associated with co-morbid conditions, particularly inflammatory conditions. The inflammatory process may
Inflammation and the acute-phase response
Effects on erythropoiesis
Effects on erythrocyte survival
Effects on iron metabolism
Serum CRP predicts epoetin resistance
Treatment with epoetin and iron in patients with inflammation
Future aspects and conclusions
Notes
References
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