title: Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis.
abstract: BACKGROUND
  The management of anemia with erythropoietin (EPO) is important in the global treatment of dialysis patients. There is a general impression that anemia control with EPO is obtained more easily in peritoneal dialysis (PD) patients than in hemodialysis (HD) patients. The EPO administration route has to be the same to compare the two techniques adequately.
  
  
  METHODS
  To compare EPO action by subcutaneous (SC) route in HD and PD, 132 stable patients were recruited (HD: 69, PD: 63) from six centers, with adequate dialysis criteria (Kt/V in HD >1.3; weekly Kt/V in PD >1.8). In a cross-sectional study, the EPO dose/week, the number of EPO doses/week, hemoglobin (Hb), ferritin, transferrin saturation index (TS), albumin and intact parathyroid hormone (iPTH) were analyzed. Iron treatment, comorbidity and ACE inhibitors (ACEI) and angiotensin II antagonist (AIIA) treatment were recorded. A multivariate regression model was used in the statistical analysis.
  
  
  RESULTS
  The mean Hb level was the same in both groups, HD 11.6 (1.3) g/dL, PD 11.4 (1.4) g/dL, p=0.3. The SC, EPO doses required to obtain the Hb levels were higher in HD than in PD patients, with a difference of 64.3 u/Kg/week, statistically significant in the multivariate regression model (p=0.001, 95% CI 42.6-86.0). The number of EPO doses/week was also higher in HD patients (65% of HD patients with > or = 3 doses, 19% of PD patients with three or more doses, p<0.001). TS was similar in both groups, while ferritin was higher in HD patients, with a higher percentage of HD patients using intravenous (i.v.) iron (HD 77% vs. PD 49%, p=0.001). Serum albumin and iPTH were lower in PD patients (p<0.001 and p=0.04, respectively), but the percentage of patients with intact parathyroid hormone (iPTH) >500 pg/mL was similar in both groups (HD 17%, PD 14%).
  
  
  CONCLUSIONS
  With the same administration route, PD patients showed a reduced EPO requirement, and less frequent EPO administration than HD patients, to obtain the same Hb level. No other factors, except those involved in better depuration of erythropoiesis inhibitors in PD, seemed responsible for the different EPO requirements.
authors.affiliation: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain. fcoronel.hcsc@salud.madrid.org
authors.forename: Francisco
authors.initials: F
authors.lastname: Coronel
authors.forename: Jose A
authors.initials: JA
authors.lastname: Herrero
authors.forename: Jesus
authors.initials: J
authors.lastname: Montenegro
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernandez
authors.forename: Argimiro
authors.initials: A
authors.lastname: Gandara
authors.forename: Jose
authors.initials: J
authors.lastname: Conesa
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Rivera
authors.forename: Jaime
authors.initials: J
authors.lastname: Torrente
authors.forename: Jose
authors.initials: J
authors.lastname: Portolés
authors.forename: Juan R
authors.initials: JR
authors.lastname: Gomez-Martino
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D003430:Cross-Sectional Studies; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D014168:Transferrin / Q000032:analysis
chemical_list: D006454:Hemoglobins; D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D012709:Serum Albumin; D014168:Transferrin; D004921:Erythropoietin; D005293:Ferritins