New insights into the thrombopoietic status of patients on dialysis through the evaluation of megakaryocytopoiesis in bone marrow and of endogenous thrombopoietin levels

Blood ◽  
2001 ◽  
Vol 97 (4) ◽  
pp. 915-921 ◽  
Author(s):  
Minoru Ando ◽  
Yuhsuke Iwamoto ◽  
Akio Suda ◽  
Ken Tsuchiya ◽  
Hiroshi Nihei
Keyword(s):  
Recombinant Human Erythropoietin ◽  
Hemodialysis Patients ◽  
Enzyme Linked Immunosorbent Assay ◽  
Dialysis Patients ◽  
Platelet Counts ◽  
Human Erythropoietin ◽  
Reticulated Platelets ◽  
Frequent Finding ◽  
Antibody Titers ◽  
Hcv Antibody

Abstract The thrombopoietic status of patients with uremia remains unclear. This issue was addressed with particular reference to marrow megakaryocytopoiesis and endogenous thrombopoietin (TPO) levels. A study was conducted in 114 patients on hemodialysis, 43 patients on continuous ambulatory peritoneal dialysis, and 48 age-matched controls. Reticulated platelets, a marker of marrow megakaryocytopoiesis, were measured by flow cytometry. Serum TPO levels, platelet-associated IgG (PAIgG) levels, and hepatitis C virus (HCV) antibody titers were also measured by enzyme-linked immunosorbent assay. Circulating and reticulated platelet counts were significantly lower in the patients on dialysis than in the controls. Thrombocytopenia (less than 150 × 109/L) was most frequent in the HCV-positive hemodialysis patients, who had a higher incidences and higher PAIgG titers. The following results were obtained in the HCV-negative dialysis patients: (1) platelet counts chronologically decreased with years on hemodialysis; (2) platelet counts were associated with the reticulated platelet counts; (3) serum TPO levels were significantly elevated in the dialysis patients, responding to the decrease of reticulated platelets; (4) hematocrits had a positive correlation with serum TPO levels, and serum TPO levels were significantly higher in the patients on hemodialysis who did not require recombinant human erythropoietin therapy than in the other patients. In conclusion, thrombocytopenia is a frequent finding in patients on dialysis. The failure of megakaryocyte production could be the principal cause of the platelet reduction, and the peripheral destruction and sequestration of platelets may be concomitantly involved. Elevation of serum TPO may in part serve as an aid to erythropoiesis in dialysis patients.

Correlation Between Recombinant Human Erythropoietin Dose and Inflammatory Status in Dialysed Patients

2017 ◽  
Vol 68 (2) ◽  
pp. 354-357 ◽  
Author(s):  
Andrei Niculae ◽  
Cristiana David ◽  
Razvan Florin Ion Dragomirescu ◽  
Ileana Peride ◽  
Flavia Liliana Turcu ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Recombinant Human Erythropoietin ◽  
Best Practice ◽  
Daily Practice ◽  
Therapeutic Benefit ◽  
Chronic Dialysis ◽  
Dialysis Patients ◽  
Protein Levels ◽  
Human Erythropoietin ◽  
Inflammatory Status

Once recombinant human erythropoietin (r-HuEPO) was introduced in daily practice, huge steps were made in combating the adverse effects induced by anemia in chronic kidney disease population. Still, r-HuEPO resistance and the doses ensuring the maximum therapeutic benefit remain matters of debate. The aim of our study was to assess the correlation between the presence and the degree of inflammation and the r-HuEPO requirements in chronic dialysis patients. We conducted a 2 years prospective study on 146 patients undergoing chronic dialysis treated with r-HuEPO. Based on their average CRP (C-reactive protein) levels, obtained from repeated samplings at 3 months interval, 3 groups were formed; we noted in each group the average values of r-HuEPO prescribed to achieve the optimum hemoglobin levels according to the dialysis best practice guidelines and all the adverse effects of the therapy. A direct correlation was observed between CRP levels and r-HuEPO requirements in the first 2 groups of patients (CRP under 6 mg/L and CRP values 6-20 mg/L), with significant increase in r-HuEPO doses between groups (p [ 0.001); the third group, CRP values over 20 mg/dL, showed a minor, insignificant increase in average r-HuEPO doses compared to mild inflammation group (p = 0.199) and more adverse effects of the therapy (p [ 0.05). Inflammation is an important determinant of anemia in chronic dialysis patients and can induce an increase in the doses of r-HuEPO. However, prescribing excessive r-HuEPO doses is not the answer in severe inflammatory status, due to lack of response and possible adverse effects.

Treatment of the Anemia of Hemodialysis Patients with Recombinant Human Erythropoietin

1988 ◽  
Vol 11 (4) ◽  
pp. 249-254 ◽  
Author(s):  
R.M. Schaefer ◽  
B. Kuerner ◽  
M. Zech ◽  
G. Denninger ◽  
C. Borneff ◽  
...  
Keyword(s):  
Recombinant Human Erythropoietin ◽  
Antibody Formation ◽  
Hemodialysis Patients ◽  
Dialysis Session ◽  
Allergic Reactions ◽  
Human Erythropoietin ◽  
Major Organ ◽  
Baseline Values ◽  
Organ Dysfunctions

Fifteen long-term hemodialysis patients suffering from stable anemia received recombinant human erytheropoietin (r-huEPO). The hormone was given intravenously at the end of each dialysis session starting with a dose of 24 IU/kg. This dose was doubled when hemoglobin levels did not rise within 2 weeks. The number of reticulocytes started to increase after 14 days of treatment. The hematocrit rose from baseline values of 23.7 ± 1.2% to 32.4 ± 1.3% after 24 weeks of treatment. In parallel, hemoglobin values increased from 7.3 ± 0.3 g/100 ml to 10.1 ± 0.4 g/100 ml. As for side effects, 3 patients developed hypertension and 2 patients suffered from occlusions of their arterio-venous fistulas. There was no evidence of major organ dysfunctions, toxic effects, allergic reactions, or antibody formation. These data show that rHuEPO is able to correct the anemia of patients undergoing hemodialysis treatment.

scholarly journals Effect of Recombinant Human Erythropoietin on Reticulocyte Age in Hemodialysis Patients

Nephron ◽  
1992 ◽  
Vol 62 (3) ◽  
pp. 366-367 ◽  
Author(s):  
P. Zachée ◽  
L. Van Hove ◽  
D. Hauglustaine ◽  
L. Veressen ◽  
M.A. Boogaerts
Keyword(s):  
Recombinant Human Erythropoietin ◽  
Hemodialysis Patients ◽  
Human Erythropoietin

Quality of Life Improvements in Capd Patients Treated with Subcutaneously Administered Erythropoietin for Anemia

1992 ◽  
Vol 12 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Juliet Auer ◽  
Gail Simon ◽  
Judith Stevens ◽  
Paul Griffiths ◽  
Deborah Howarth ◽  
...  
Keyword(s):  
Social Life ◽  
Recombinant Human Erythropoietin ◽  
Nottingham Health Profile ◽  
Hemodialysis Patients ◽  
Health Profile ◽  
Emotional Wellbeing ◽  
Household Tasks ◽  
Human Erythropoietin ◽  
Before And After

Twenty -two continuous ambulatory peritoneal dialysis (CAPD) patients, mean age 48 years, at 3 U.K. renal units were assessed with the Nottingham Health Profile (N HP) before and after treatment with recombinant human erythropoietin (r-HuEPO). Mean (SD) hemoglobin (Hb) at baseline was 7.5 (1.0) gIn/dl and 10.8 (1.5) gIn/dl at retest. There were significant improvements in energy (p<0.0001), social life (p<0.005), relationships at home (p<0.05) and leisure pursuits (p<0.05). Twelve patients, mean age 51 years, who had already completed more than 9 months on r-HuEPO treatment were reassessed to determine the changes sustained. Mean (SD) Hb at second retest was 12.8 (1.3) gm/dl. Improvement in energy continued to be significant, and emotional wellbeing showed further improvement. Problems with household tasks, which had not shown significant improvement at Test B, were now considerably reduced (p=0.016). The study showed far-reaching benefits similar to those reported in hemodialysis patients, in a population with a higher mean age and higher potential coexisting illness or disability than most reported hemodialysis studies.

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