Variations in erythropoiesis and serum ferritin during erythropoietin therapy for anaemia of end-stage renal disease.
In order to study the relationship between erythropoiesis and serum ferritin (SF) during erythropoietin (rHuEPO) therapy in the anaemia of end-stage renal disease (ESRD), 19 patients were followed without iron supplementation and at a fixed dose of the drug (40 U/kg). Twelve patients failed to attain the target haemoglobin (Hb) value, 7 of whom due to the appearance of iron deficiency. Erythropoiesis, as measured by the serum transferrin receptor concentration, increased from 12 to 120% of the basal value. This increment was not constantly associated with a proportional rise of Hb or reticulocyte count. SF decreased exponentially from a median value of 221 micrograms/dl (range 42-470) to a median value of 54 micrograms/dl (range 20-172). Halving of the basal SF value (SF-T50) was reached at the 18th-95th day of therapy (median = 43), representing a iron shift of 3.4-11.6 mg/day (median = 5.4). SF-T50 was not correlated with the Hb increase, but with that of erythropoiesis (r = 0.78; p = 0.003). The minimum SF (MSF) value attained was not correlated with the appearance of iron deficiency. The conclusion is that the rate of SF decrease during rHuEPO in ESRD is a reliable measure of iron mobilisation for erythropoiesis, but not for haematologic response. The MSF value reached during therapy is not representative of available iron for erythropoiesis.
Barosi
G
G
Department of Internal Medicine and Medical Therapy, University of Pavia, Italy.
Merlo
C
C
Palestra
P
P
Liberato
N L
NL
Guarnone
R
R
Di Dio
F
F
Piazza
V
V
Salvadeo
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology; D003131:Combined Modality Therapy; D004920:Erythropoiesis / Q000187:drug effects*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005293:Ferritins / Q000097:blood* / Q000187:drug effects*; D006454:Hemoglobins / Q000032:analysis / Q000187:drug effects; D006801:Humans; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011990:Receptors, Transferrin / Q000032:analysis / Q000187:drug effects; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis; D013997:Time Factors; D017211:Treatment Failure
D006454:Hemoglobins; D011990:Receptors, Transferrin; D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron