title: rHuEPO hyporesponsiveness and related high dosages are associated with hyperviscosity in maintenance hemodialysis patients.
abstract: OBJECTIVE
  Increased viscosity may increase the risk of thrombosis or thromboembolic events. Recombinant human erythropoietin (rHuEPO) is the key stone treatment in anemic ESRD patients with the thrombotic limiting side effect. We evaluated the influence of clinical and laboratory findings on plasma viscosity in MHD patients in the present study.
  
  
  METHODS
  After applying exclusion criteria 84 eligible MHD patients were included (30 female, age: 54.7 ± 13.7 years).
  
  
  RESULTS
  Patients with high viscosity had longer MHD history, calcium × phosphorus product, and higher rHuEPO requirement (356.4 versus 204.2 U/kg/week, P: 0.006). rHuEPO hyporesponsiveness was also more common in hyperviscosity group. According to HD duration, no rHuEPO group had the longest and the low rHuEPO dosage group had the shortest duration. Despite similar Hb levels, 68% of patients in high rHuEPO dosage group; and 38.7% of patients in low rHuEPO dosage group had higher plasma viscosity (P: 0.001). Patients with hyperviscosity had higher rHuEPO/Hb levels (P: 0.021). Binary logistic regression analyses revealed that rHuEPO hyporesponsiveness was the major determinant of hyperviscosity.
  
  
  CONCLUSIONS
  We suggest that the hyperviscous state of the hemodialysis patients may arise from the inflammatory situation of long term HD, the calcium-phosphorus mineral abnormalities, rHuEPO hyporesponsiveness, and related high dosage requirements.
authors.affiliation: Department of Nephrology, Baskent University Medical School, 06490 Ankara, Turkey.
authors.forename: Mehtap
authors.initials: M
authors.lastname: Erkmen Uyar
authors.forename: Selami Kocak
authors.initials: SK
authors.lastname: Toprak
authors.forename: Hatice
authors.initials: H
authors.lastname: Saglam
authors.forename: Emre
authors.initials: E
authors.lastname: Tutal
authors.forename: Meltem
authors.initials: M
authors.lastname: Bay
authors.forename: Osman
authors.initials: O
authors.lastname: Ilhan
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Bal
authors.forename: Siren
authors.initials: S
authors.lastname: Sezer
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001809:Blood Viscosity; D002118:Calcium / Q000097:blood; D004351:Drug Resistance; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010758:Phosphorus / Q000097:blood; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D006435:Renal Dialysis; D013923:Thromboembolism / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D010758:Phosphorus; D007501:Iron; D002118:Calcium