Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis.
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.
Coronel
Francisco
F
Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain. fcoronel.hcsc@salud.madrid.org
Herrero
Jose A
JA
Montenegro
Jesus
J
Fernandez
Cristina
C
Gandara
Argimiro
A
Conesa
Jose
J
Rivera
M Teresa
MT
Torrente
Jaime
J
Portolés
Jose
J
Gomez-Martino
Juan R
JR
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
D006454:Hemoglobins; D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D012709:Serum Albumin; D014168:Transferrin; D004921:Erythropoietin; D005293:Ferritins