NDT Advance Access originally published online on October 19, 2007
Nephrology Dialysis Transplantation 2008 23(1):412-413; doi:10.1093/ndt/gfm717
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Haemoglobin and erythropoietin levels in polycystic kidney disease
Email: edealmeida{at}mail.telepac.ptSir,
Artunc and Risler [1] recently proposed a nomogram allowing an easy interpretation of serum erythropoietin values (EPO) by plotting them against haemoglobin using percentiles. They found that EPO correlated inversely with haemoglobin and patients with chronic kidney disease (CKD) of various aetiologies preserved the feedback loop although at a lower level, with most patients below the 25th percentile.
Interestingly, patients with polycystic kidney disease (PKD) were excluded based on the assumption that this entity is associated with increased EPO concentration irrespective of renal function. Although there are several reports claiming that patients with PKD had higher levels of haemoglobin and EPO [2,3], our data only partially support this view. In fact, in a cohort of 259 patients with PKD, in several stages of CKD, haemoglobin levels were only significantly higher in PKD patients in stages 3 and 4, when compared to 87 patients with other causes of CKD (Figure 1). In addition, in our practice, many patients with PKD have to start an erythropoietic-stimulating agent (ESA) in order to treat renal anaemia. We performed a radio-immunoassay determination of serum EPO (DSL1100EPOkit) in 107 patients with PKD and in 35 patients with CKD of other aetiologies, at various stages of CKD; none was on ESA, nor had other causes for anaemia. In PKD patients in stage 2, there is a significant rise in serum EPO levels that is not accompanied by a similar elevation of haemoglobin. In later stages, there is a continuous fall in haemoglobin. In early stages of CKD of other aetiologies, there is a significant negative correlation between EPO and haemoglobin that is lost in stages 4 and 5, but no correlation was found, in any stage, in patients with PKD. By plotting EPO against haemoglobin (Figure 2), it is clear that most values are below the 25th percentile and that there is no difference between PKD and other causes of CKD.
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It has been demonstrated that cystic fluid and interstitial cells produce erythropoietin independent to the oxygen content [4], and this has been the main argument for the opinion that PKD patients produce more EPO than others. Although this may be true in early stages of CKD with volume expansion [5], this effect may be offset in the later stages as a result of uraemia. Therefore as PKD progresses, more cysts produce more EPO and may contribute to higher haemoglobin in stages 3 and 4. In stage 5, the inhibitory effect of uraemia may block the response of bone marrowto EPO. Our data are limited because the number of patients in the control group is small. Besides this limitation, our results show the utility of the nomogram in a clinical setting and that PKD patients have higher haemoglobin only in early stages.
Conflict of interest statement. None declared.
1Serviço de Nefrologia e
Transplantacção Renal
Hospital de, Santa Maria
Lisboa, Portugal
2Cadeira de Genética
Faculdade de, Medicina de Lisboa
Lisboa, Portugal
References
- Artunc F, Risler T. Serum erythropoietin concentrations and responses to anemia in patients with or without chronic kidney disease. Nephrol Dial Transpl (2007) 22:2900–2908.
[Abstract/Free Full Text] - Maggiore Q, Navalesi R, Biagini M, et al. Comparative studies on uraemic anaemia in polycystic kidney disease and in other renal diseases. Proc Eur Dial Transpl (1976) 4:264–269.
- Chandra M, Miller ME, Garcia JF, et al. Serum erythropoietin levels in patients with polycystic kidney disease as compared with other hemodialysis patients. Nephron (1985) 39:26–29.[Web of Science][Medline]
- Eckardt KU, Möllmann M, Neumann R, et al. Erythropoietin in polycystic kidneys. J Clin Invest (1989) 84:1160–1166.[Web of Science][Medline]
- Grantham JJ, Torres VE, Chapman AB, et al. Volume progression in polycystic kidney disease. N Engl J Med (2006) 354:2122–2130.
[Abstract/Free Full Text]
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