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Nephrol Dial Transplant (1999) 14: 2625-2627
© 1999 European Renal Association-European Dialysis and Transplant Association

Dialysis and Transplantation News

Erythropoietin resistance due to dialysate chloramine: the two-way traffic of solutes in haemodialysis

Donald Richardson1, Cherry Bartlett1, Eddie Goutcher1, Colin H. Jones2, Alex M. Davison1 and Eric J. Will1

1 Department of Renal Medicine, St James's University Hospital, Leeds and 2 Department of Renal Medicine, York District General Hospital, York, UK

Correspondence and offprint requests to: Dr Donald Richardson, Renal Research Registrar, Department of Renal Medicine, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.

Keywords: anaemia; chloramine; erythropoietin resistance; haemodialysis; haemolysis; renal failure

Introduction

Renal anaemia is primarily a consequence of erythropoietin deficiency and is amenable to treatment with exogenous erythropoietin. Erythropoietin is expensive and can consume a large proportion of the budget for end-stage renal replacement therapy so that any cause of erythropoietin resistance has important resource implications. The usual cause of erythropoietin resistance is inadequate available iron for erythropoiesis in the bone marrow although the definitive list is long [1]. We developed a clinical management system in an attempt to improve the cost-benefit ratio for erythropoietin and intravenous iron therapy in our haemodialysis population. We encountered a potent and insidious cause of anaemia in a subset of our haemodialysis population from a recognized cause not usually included in such a list. Investigations were prompted by continuous audit of the management of renal anaemia, which indicated that patients in . . . [Full Text of this Article]

Cohort study

Discussion

Water quality and haemodialysis
Chlorine as a toxic additive to water
Ascorbic acid and chloramine activity
Conclusion

Notes

References


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E. J. Will, D. Richardson, C. Tolman, and C. Bartlett
Development and exploitation of a clinical decision support system for the management of renal anaemia
Nephrol. Dial. Transplant., June 1, 2007; 22(suppl_4): iv31 - iv36.
[Abstract] [Full Text] [PDF]