title: Timing and determinants of erythropoietin deficiency in chronic kidney disease.
abstract: OBJECTIVE
  Anemia in patients with CKD is highly related to impaired erythropoietin (EPO) response, the timing and determinants of which remain unknown.
  
  
  METHODS
  This study measured EPO levels and studied their relation to GFR measured by 51Cr-EDTA renal clearance (mGFR) in 336 all-stage CKD patients not receiving any erythropoiesis-stimulating agent.
  
  
  RESULTS
  In patients with anemia defined by World Health Organization criteria (hemoglobin [Hb] <13 g/dl in men and 12 g/dl in women), EPO response to Hb level varied by mGFR level. EPO and Hb levels were negatively correlated (r=-0.22, P=0.04) when mGFR was >30 ml/min per 1.73 m(2), whereas they were not correlated when mGFR was <30 (r=0.09, P=0.3; P for interaction=0.01). In patients with anemia, the ratio of observed EPO to the level predicted by the equation for their Hb level decreased from 0.72 (interquartile range, 0.57-0.95) for mGFR ≥60 ml/min per 1.73 m(2) to 0.36 (interquartile range, 0.16-0.69) for mGFR <15. Obesity, diabetes with nephropathy other than diabetic glomerulopathy, absolute iron deficiency, and high C-reactive protein concentrations were associated with increased EPO levels, independent of Hb and mGFR.
  
  
  CONCLUSIONS
  Anemia in CKD is marked by an early relative EPO deficiency, but several factors besides Hb may persistently stimulate EPO synthesis. Although EPO deficiency is likely the main determinant of anemia in patients with advanced CKD, the presence of anemia in those with mGFR >30 ml/min per 1.73 m(2) calls for other explanatory factors.
authors.affiliation: INSERM, CESP Centrefor Research inEpidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney DiseasesTeam, Villejuif, France. lucile.mercadal@inserm.fr
authors.forename: Lucile
authors.initials: L
authors.lastname: Mercadal
authors.forename: Marie
authors.initials: M
authors.lastname: Metzger
authors.forename: Nicole
authors.initials: N
authors.lastname: Casadevall
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Haymann
authors.forename: Alexandre
authors.initials: A
authors.lastname: Karras
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Boffa
authors.forename: Martin
authors.initials: M
authors.lastname: Flamant
authors.forename: François
authors.initials: F
authors.lastname: Vrtovsnik
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Stengel
authors.forename: Marc
authors.initials: M
authors.lastname: Froissart
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004921:Erythropoietin / Q000097:blood / Q000172:deficiency*; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007674:Kidney Diseases / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin
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