Abstract: SA-PO794

Endogenous Erythropoietin and Requirement of Erythropoietin Supplementation in Hemodialysis Patients

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Sola, Laura, CASMU-IAMPP, Montevideo, Uruguay
  • Gonzalez, Susana B., CASMU-IAMPP, Montevideo, Uruguay
  • Diaz, Juan Carlos, CASMU-IAMPP, Montevideo, Uruguay
  • Miranda, Veronica, CASMU-IAMPP, Montevideo, Uruguay
  • Fajardo, Laura C, CASMU-IAMPP, Montevideo, Uruguay
  • Hermo, Ricardo Antonio, CASMU-IAMPP, Montevideo, Uruguay
Background

Anemia is frequent in hemodialysis (HD) patients (Pts) and is associated to increased morbidity and mortality, being the main cause decreased erythropoietin (EPO) production.
The objective of this study is to measure endogenous EPO (EPOe), and asses its relationship with hemoglobin (Hb) and required dose of erythropoietin supplementation (EPOsup) in HD Pts.

Methods

EPOe was measured in HD Pts older than 18 years on treatment in the HD Unit of CASMU on February 2017. Were excluded Pts with evident bleeding, neoplasia, acute infection or hospitalization in the previous month. Data was registered regarding gender, age, and residual renal function (RRF) (creatinine clearance when diuresis ≥300 ml/day)
EPOe and Hb were measured after 1 week without EPOsup, in midweek HD, with Advia 2010, Siemens. EPOe was considered low when <4.3, normal value 4.3 to 29 and high >29 mUI/ml.
EPO dose was considered as UI/Kg/week, and its response as Hb/EPO dose
Quantitative data was expressed as mean and standard deviation or median and interquartile range (IQ), and compared by t test or ANOVA, and categorical measures expressed by percentage and compared by chi square. Significant differences were considered with p values <0.05.

Results

We studied 134 Pts, 83 men (61.9%), median age 70 (IQ 60-79) years, 44 diabetics (32.8%), HD vintage 28 months (IQ 14-49). Diuresis in 54 Pts was 800 (IQ 500-1350) ml/day, with RRF 6,4 (IQ 2,8-9,3) ml/min.
Median EPOe was 9.4 (6.6-13.7) mUI/ml. Low EPOe in 10 (7.5%), normal in 116 (86.5%), and high in 8 Pts (6.0%). Pts who did not received EPOsup (19) not differ regarding mean age, HD vintage or EPOe with those with EPOsup. Hb levels were significantly higher in those Pts without EPOsup (12.4±1.1 vs 11.1±1.1 g/dL).
EPO categories did not differ regarding age, gender, diabetes, Hb levels or EPO dose. Higher EPOe levels were significantly associated to higher vintage (low EPOe 36.7 ± 23.5, normal EPOe 35.7 ± 41.4 and high EPOe 77.6 ± 70.6 months).

Conclusion

Unexpectedly only 7.5% of the Pts had low EPOe, even though normal levels are inadequate in anemic Pts. Higher EPOe in Pts with longer dialysis vintage may suggest others sources for EPOe besides kidneys in these Pts.

Funding

  • Clinical Revenue Support