Skeletal effects of erythropoietin in hemodialysis patients.
OBJECTIVE
To assess the effects of erythropoietin (EPO) on bone metabolism in patients receiving chronic hemodialysis (HD).


METHODS
Forty one patients were divided into two groups whether they required the administration of EPO to treat renal anemia or not. Serial measurements of predialysis blood samples and bone mineral density were performed prospectively over a year.


RESULTS
The administration of EPO was associated with an increased serum creatinine (11.9 +/- 0.4 to 12.5 +/- 0.4 mg/dl, p < 0.05), insulin-like growth factor binding protein (3.0 +/- 0.2 to 3.4 +/- 0.2 micrograms/ml, p < 0.05) as well as decreased iron level (112 +/- 7 to 88 +/- 7 micrograms/dl, p < 0.005). Furthermore, in EPO-treated group, exogenous EPO doses correlated with the increments in 1,25-dihydroxy-vitamin D (r = 0.38, p < 0.05), intact osteocalcin (r = 0.42, p < 0.05) and bone alkali-phosphatase (r = 0.53, p < 0.005), but not intact parathyroid hormone (r = 0.09). Both metacarpal index (0.47 +/- 0.02 to 0.47 +/- 0.02) and the summation of gray scale/diameter (2.68 +/- 0.06 to 2.61 +/- 0.07 mmAl), bone mineral density parameters, remained unchanged.


CONCLUSIONS
The present data provide evidence that EPO may modulate the production of 1,25-dihydroxy-vitamin D in HD patients. Furthermore, our findings suggest that EPO therapy activates insulin-like growth factor system in HD patients, possibly through its actions on metabolism.
Takenaka
Tsuneo
T
Shinjuku Suimei Clinic, Shinjuku, Tokyo, Japan.
Itaya
Yoshiaki
Y
Ishikawa
Ichiro
I
Kobayashi
Kenji
K
Tsuchiya
Yoshitsugu
Y
D000704:Analysis of Variance; D000747:Anemia, Hypochromic / Q000188:drug therapy* / Q000209:etiology; D001774:Blood Chemical Analysis; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D016022:Case-Control Studies; D003720:Densitometry; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome
D011994:Recombinant Proteins; D004921:Erythropoietin