The role of aluminium and parathyroid hormone in erythropoietin resistance in haemodialysis patients.
Recombinant human erythropoietin (rHuEpo) is an effective therapy for anaemia in most patients with end-stage renal disease (ESRD). However, there remain a minority of patients with ESRD who are resistant to the effects of rHuEpo. The present study examined the role of aluminium overload and hyperparathyroidism of the biological effects of rHuEpo. Twenty-two patients aged 26-74 (mean 53 +/- SD 15.5) received rHuEpo 50-200 U/kg per week for 16.5 +/- 8.0 months (range 3-27). Haemoglobin was maintained at 11.5-13.0 g/dl by appropriate dose adjustment. Iron supplements were provided to maintain serum ferritin greater than 200 ng/ml. The mean time to rHuEpo response (Hb greater than 2 g/dl over baseline) was 6.1 +/- 2.6 weeks. Mean pretreatment serum aluminium correlated with time to Hb response (r = 0.48; P less than 0.05) and pretreatment mean corpuscular volume (r = 0.43; P less than 0.05) but not with eventual rHuEpo maintenance dose. PTH did not correlate with either Hb response or eventual maintenance rHuEpo dose. In summary, elevated serum aluminium concentrations were associated with an initial resistance to the biological effects of rHuEpo but had no effect on long-term dose requirements. In contrast, no impact of PTH on either immediate or long-term rHuEpo dose was evident.
Muirhead
N
N
Department of Medicine, University of Western Ontario, London, Canada.
Hodsman
A B
AB
Hollomby
D J
DJ
Cordy
P E
PE
D000328:Adult; D000368:Aged; D000535:Aluminum / Q000097:blood / Q000502:physiology*; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004921:Erythropoietin / Q000627:therapeutic use*; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood / Q000502:physiology*; D011994:Recombinant Proteins; D006435:Renal Dialysis
D006454:Hemoglobins; D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins; D000535:Aluminum