The effect of recombinant human erythropoietin on haematopoiesis in patients undergoing haemodialysis.
OBJECTIVE
To define the effect of intravenous recombinant human erythropoietin (rHuEPO) in patients with anaemia caused by chronic renal failure. Data collection included bone marrow response, ferrokinetics, red cell survival as well as the influence on red cell mass and plasma volume.


METHODS
A convenience sample of stable individuals on haemodialysis, with haemoglobin (Hb) levels of less than 80 g/l, was surveyed over a 12-week period while they were receiving the hormone. Blood counts and iron studies were monitored serially, while 51Cr-labelled red cells and 59Fe (III) citrate were used in the radionuclide investigations carried out before and after the course of replacement therapy was completed (pre and post injection). Bone marrow aspiration and trephine biopsy were performed at each of these times.


RESULTS
The actual mean trial period was 14 weeks. Eight patients were enrolled but 1 was withdrawn after developing tuberculosis at the start of the study. Haemoglobin levels rose from 59 g/l (SD 8.8) to 96 g/l (SD 13.9) (P < 0.0001); mean red cell mass rose from 675 ml to 954 ml (P < 0.01). Concurrently, the serial studies in 6 patients showed prominent erythroid hyperplasia. Plasma iron turnover increased insignificantly from 42.5 to 118.9 mumol/l/day; erythron turnover increased from 42.5 to 87.3 mumol/l/day (P < 0.01). There was a marked shortening of the marrow transit time from 4.4 to 3.3 days (P < 0.03). Efficacy of erythropoiesis decreased from 1.17 to 0.65 (P < 0.05). Red cell survival was not altered.


CONCLUSIONS
The patient with end-stage renal failure remains fully responsive to erythropoietin therapy. This is reflected in improved ferrokinetics, red cell hyperplasia in the marrow and rise in haemoglobin level without alteration in mean erythrocyte lifespan. Simple hormonal replacement is therefore a rational approach to management.
Swanepoel
C
C
University of Cape Town Leukaemia Centre.
Jacobs
P
P
Byrne
M J
MJ
Rayner
B
B
Cassidy
M J
MJ
Meyer
J
J
D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D004909:Erythrocyte Indices; D004921:Erythropoietin / Q000008:administration & dosage / Q000494:pharmacology*; D006410:Hematopoiesis / Q000187:drug effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000494:pharmacology*
D011994:Recombinant Proteins; D004921:Erythropoietin