Erythropoietin therapy improves graft patency with no increased incidence of thrombosis or thrombophlebitis.
BACKGROUND
Recombinant human erythropoietin (rHuEPO) for the treatment of severe anemia in patients with end-stage renal disease (ESRD) is suggested to improve rehabilitation and cognitive function. The criticism is the alleged increase in the failure rate of arteriovenous (AV) access grafts and in the incidence of lower-extremity deep venous thrombophlebitis (DVT). This study addressed the longevity of AV grafts and the incidence of DVT.


METHODS
We reviewed 481 consecutive patients with ESRD on dialysis with PTFE access grafts, including 173 consecutive patients who were receiving rHuEPO and 308 who were not. rHuEPO was administered during dialysis titrated against the hematocrit to achieve a level of 33% to 38%. The rHuEPO-ESRD group included 173 patients with a mean age of 58 years, including 54% women; 84% of the grafts were in the upper extremity. In the control group of 308 patients, 57% were women. Diabetes and hypertension were controlled in both groups.


RESULTS
Forty-five of 173 rHuEPO patients (26%) experienced graft thrombosis within 1 year. Among 88 episodes of thrombosis, 14 patients experienced multiple episodes. Primary patency was 8.9 months; secondary patency was 11.2 months. In the control population, 95 of 308 patients (31%) experienced graft thrombosis; 27 patients had multiple episodes. Primary patency was 7.8 months and secondary patencywas 9.8 months. The hematocrit improved from a mean of 23% in the control group to 34% in the treated rHuEPO group. Two patients in the control group and one patient receiving rHuEPO experienced DVT in the lower extremity.


CONCLUSIONS
Primary and secondary AV fistula patency rates were improved by 10% with rHuEPO. rHuEPO did not increase DVT.
Martino
M A
MA
Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA.
Vogel
K M
KM
O'Brien
S P
SP
Kerstein
M D
MD
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D004921:Erythropoietin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000139:chemically induced*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012189:Retrospective Studies; D013924:Thrombophlebitis / Q000139:chemically induced*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects*
D011994:Recombinant Proteins; D004921:Erythropoietin; D011138:Polytetrafluoroethylene