Aluminium interference in the treatment of haemodialysis patients with recombinant human erythropoietin.
In nine chronic haemodialysis patients a desferrioxamine (DFO) load test (40 mg/kg body-weight) was performed 1 year after the beginning of treatment with recombinant human erythropoietin (rHuEpo). The patients were then divided into two groups. Group A comprised five patients with a greater mean aluminium (204 +/- 28 micrograms/l) than the four patients in group B. Group A was given a mean dose of 25.8 g (range 14-39 g) of DFO over 6 months. Group B (aluminium values 112 +/- 36 micrograms/l) was never treated with DFO. During the period of observation, plasma iron, serum ferritin and transferrin, as well as iron supplementation, did not differ between the groups. After DFO treatment a second DFO load test was performed. The mean predialysis aluminium value was significantly reduced in group A (204 +/- 28 vs 111 +/- 72 micrograms/l; P less than 0.05), while remaining unchanged in group B (112 +/- 36 vs 140 +/- 39 micrograms/l; P = ns). In both groups, the doses of rHuEpo necessary to maintain the same haemoglobin values decreased with time, but reduced significantly only in group A (298 +/- 105 vs 110 +/- 61 mu/kg per week; delta -63%; P less than 0.01). Thus, aluminium interferes with the response to rHuEpo in haemodialysis patients, and the correction of aluminium overload with DFO can allow a considerable sparing of rHuEpo.
Casati
S
S
Divisione di Nefrologia, IRCCS Ospedale Maggiore, Milan, Italy.
Castelnovo
C
C
Campise
M
M
Ponticelli
C
C
D000328:Adult; D000535:Aluminum / Q000097:blood*; D000740:Anemia / Q000188:drug therapy; D003676:Deferoxamine / Q000494:pharmacology; D004921:Erythropoietin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis
D011994:Recombinant Proteins; D004921:Erythropoietin; D000535:Aluminum; D003676:Deferoxamine