The effects of therapeutic dialysis and renal transplantation on uraemic serum inhibitors of erythropoiesis in vitro.
The methyl cellulose culture system using human bone marrow and erythropoietin (Ep) at different concentrations was used to examine the effects of uraemic sera on erythropoiesis in vitro. Sera from undialysed patients with advanced uraemia (plasma creatinine greater than 900 mumol/l) when added to cultures at 10% with Ep at 2.0 u/ml were consistently inhibitory to the growth of erythroid burst-forming units (BFU-E). No inhibition of erythroid colony-forming units (CFU-E) was observed at this Ep concentration but inhibition was consistently demonstrated with Ep at 0.2 u/ml. Sera from undialysed patients with less severe uraemia (plasma creatinine less than 900 mumol/l) were not inhibitory to BFU-E or CFU-E at Ep 2.0 u/ml. Sera from patients with stable, functioning renal transplants were stimulatory to erythropoiesis in vitro with Ep at 2.0 u/ml. This finding is consistent with the normal or increased haematocrits often found following renal transplantation. Sera from patients on maintenance haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) were not significantly different from normal in their effect on BFU-E growth in vitro and were slightly but significantly stimulatory to the growth of CFU-E. This suggests that these two forms of dialysis are equally effective in reducing the activity of uraemic inhibitors in serum and that inhibition of the marrow response to Ep and/or burst-promoting activity (BPA) is unlikely to be a major factor in the continued anaemia of dialysis patients.
D001854:Bone Marrow Cells; D002478:Cells, Cultured; D004920:Erythropoiesis; D004921:Erythropoietin / Q000494:pharmacology; D006801:Humans; D016030:Kidney Transplantation; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D014511:Uremia / Q000097:blood*
D004921:Erythropoietin