Nephrology Dialysis Transplantation, Vol 12, Issue 11 2375-2379, Copyright © 1997 by Oxford University Press
T Linde, B Sandhagen, B Wikstrom and B Danielson
Background: Renal anaemia is rapidly corrected by
recombinant human erythropoietin (rHuEpo) therapy, but the dose required
varies greatly. Since impaired erythrocyte deformability may be one factor
contributing to the development of renal anaemia, the interrelationship
between that variable and the rHuEpo requirement was examined.
Methods: Twenty-five patients treated with
hemodialysis and rHuEpo for at least 6 months were included in the study.
The Hb value had been stable and the rHuEpo dose unchanged the last two
months. Using a rotational viscometer, the fluidity of erythrocytes,
separated from plasma and re-suspended in isotonic buffered saline to a
standardized haematocrit, was taken as a measure of erythrocyte
deformability. Results: The average weekly dose of
s.c. epoetin alpha was 186±93 U/kg body weight (range 56-370).
The dose was correlated to the reticulocyte fraction (R-0.69, P=0.0001).
When the rHuEpo dose was used as dependent variable and blood haemoglobin
concentration, serum (S) albumin, S ferritin, S aluminium, S PTH, S urea,
Kt/V/week, erythrocyte fluidity, and plasma viscosity were used as
independent variables in a stepwise multiple regression analysis, only
erythrocyte fluidity remained significantly negatively correlated to the
rHuEpo dose (R=0.5, P=0.01). Despite a tendency towards higher doses of
rHuEpo in patients with a C-reactive protein concentration exceeding 20
mg/l, the Hb was lower in these patients. Conclusions:
We conclude that the interindividual differences in bone marrow response to
rHuEpo were small in these patients. Impaired erythrocyte deformability and
inflammation seem to be factors associated with increased rHuEpo
requirement. Key words: aluminium; erythrocyte
deformability; erythropoietin; inflammation; parathyroid hormone; plasma
viscosity
ORIGINAL ARTICLES
The required dose of erythropoietin during renal anaemia treatment is related to the degree of impairment in erythrocyte deformability
Departments of Internal Medicine and Clinical Physiology, University Hospital, S-751085 Uppsala, Sweden; Corresponding author
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