[The correction of anemia with a high requirement for transfusion in patients on maintenance hemodialysis by conventional and reduced doses of recombinant human erythropoietin].
The hematologic findings of chronic renal failure are consistent with hypoproliferative anemia; the pathogenesis of the anemia is primarily due to decreased erythropoietin production by the diseased kidneys. There are aggravating factors (AF) contributing to this primordial cause: inhibitors to erythroid marrow function, shortened red cell survival, nonevident chronic blood loss (owing to uremic platelet dysfunction), iron and/or folate deficiency, aluminium toxicity, hemolysis (acute or chronic), etc. Ten patients with end stage renal disease, treated with maintenance hemodialysis and high transfusional requirement (more than 300 ml/month) are presented; in five the AF were discarded by a previously presented protocol (Table 1) and they were treated with human recombinant erythropoietin (r-HuEPO) intravenously, in conventional schemes (three times a week) and doses (195 +/- 41 Units/Kg)-Group A-. The AF were not studied in the other five and the r-HuEPO treatment employed different doses (125 +/- 70 U/K/W) and protocols (1.7 +/- 0.5 times a week)-Group B-(Table 2). The transfusional requirement disappeared and the hematocrit and the hemoglobin rose significantly in both groups (more in group A) (Table 3). The significant drop in ferritin levels (147 +/- 30 ng/ml vs 27.5 +/- 11 ng/ml at the 12th week) and the stabilization in reticulocyte count (1.4% at start vs 2% at 12th week) indicate iron consumption; in the meantime, the persistent increment in reticulocyte production index (1 at start vs 3 at 12th week) revealed a continuous stimulation of the erythropoiesis (Fig. 1). No clinical and/or vascular complications were observed; arterial pressure and serum potassium levels did not rise significantly so that r-HuEPO treatment was not canceled in any case.(ABSTRACT TRUNCATED AT 250 WORDS)
Sivak
L
L
Centro Integral de Nefrología y Trasplantes, Sanatorio Güemes, Buenos Aires, Argentina.
Scuteri
R M
RM
Cavalli
N H
NH
Gotlieb
D
D
López Blanco
O A
OA
D000328:Adult; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D001803:Blood Transfusion; D003131:Combined Modality Therapy; D004341:Drug Evaluation; D004921:Erythropoietin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects
D011994:Recombinant Proteins; D004921:Erythropoietin
Corrección de la anemia con alto requerimiento transfusional de pacientes en hemodiálisis de mantenimiento mediante dosis convencionales y reducidas de eritropoyetina recombinante humana.