Circulating burst-forming-unit erythroid and the responsiveness to recombinant human erythropoietin in patients on regular hemodialytic treatment.
The dose of recombinant human erythropoietin (r-HuEpo) required to correct anemia of end-stage renal disease varies among patients. The possible factors that interfere with the responsiveness to r-HuEpo were not completely known. In 32 patients on regular hemodialytic treatment with marked anemia (Hb 5.6 +/- 0.7 g/dl), we evaluated circulating erythroid progenitor cells [burst-forming-unit erythroid (BFU-E)], erythropoietin, ferritin, folate and 1-84-parathormone levels before r-HuEpo therapy. In 12 patients, the aluminum levels after deferoxamine were also evaluated. The possible correlation between these factors and the response to r-HuEpo therapy was then evaluated. The number of circulating (c) BFU-E was highly variable (521 +/- 447 colonies/ml of blood; normal level 742 +/- 192) and does not correlate with erythropoietin, ferritin, folate, 1-84-parathormone or aluminum levels. A direct correlation between basal cBFU-E and the responsiveness to r-HuEpo therapy was recorded while no correlation was found with the other analyzed parameters. We hypothesized that low basal cBFU-E (interleukin-3 deficiency?) could reduce the response to r-HUEpo because of failure of this hematopoietic stem cell compartment to replenish the pool of more mature erythropoietic progenitor cells during the phase of accelerated maturation induced by r-HuEpo.
Brunati
C
C
Divisione Nefrologia e Dialisi, Ospedale Niguarda Cà Granda, Italia.
Cappellini
M D
MD
De Feo
T
T
Stefanoni
I
I
Civati
G
G
Ballerini
L
L
Fiorelli
G
G
Minetti
L
L
D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D004906:Erythrocyte Count; D015672:Erythroid Precursor Cells / Q000187:drug effects*; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D005293:Ferritins / Q000097:blood; D005492:Folic Acid / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D010281:Parathyroid Hormone / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*
D006454:Hemoglobins; D010281:Parathyroid Hormone; D004921:Erythropoietin; D005293:Ferritins; D005492:Folic Acid