18 Erythropoietin Requirements in Chronic Hemodialysis Patients After Failure of Kidney Transplant

Abstract

Introduction Studies have shown that presence of a failed kidney transplant in patients returning to chronic hemodialysis following failure of their kidney transplant is associated with chronic inflammatory state and erythropoietin resistance. The aim of our retrospective clinical study was to analyze erythropoietin requirements in chronic hemodialysis patients after failure of kidney transplant.Patients and methods Fifteen chronic hemodialysis patients after failure of kidney transplant, 11 males and 4 females, at the mean age of 47.3 ± 13.3 years (range 21–65 years), were included in the study. Twelve patients had a failed kidney transplant still in place (group A) and 3 patients were had had a failed transplant nephrectomy (group B). Hemoglobin level (Hb), erythropoietin dose per week (EPO/week), erythropoietin dose per week per dry body weight (EPO/week per bw), erythropoietin resistance index (ERI = EPO/week per bw per Hb), C‐reactive protein (CRP), albumin level, ferritin level, transferrin saturation (TS) and creatinine level were analyzed monthly from January to September 2004.Results (see Table A18) Group A Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Hb (g/L) 116.8 ± 10.5 112.0 ± 12.0 114.1 ± 10.3 114.8 ± 7.8 114.9 ± 13.6 111.4 ± 13.4 110.3 ± 10.8 111.7 ± 10.9 112.9 ± 16.0 EPO/week (IU/week ) 10 444 ± 6 654 10 000 ± 7 123 10 333 ± 6 652 10 444 ± 6 267 10 909 ± 5 804 10 375 ± 6 146 10 583 ± 5 534 9 727 ± 5 101 10 273 ± 5 179 EPO/week/bw (IU/week/kg) 169.0 ± 100.3 160.1 ± 108.2 166.6 ± 101.1 168.1 ± 93.5 177.6 ± 88.1 170.0 ± 95.2 171.6 ± 87.2 159.3 ± 79.9 171.4 ± 85.8 ERI (IU/week/kg/g/dL) 15.1 ± 11.3 14.9 ± 8.9 14.7 ± 8.3 16.1 ± 9.0 17.4 ± 8.7 16.0 ± 8.6 14.7 ± 8.2 16.2 ± 9.6 15.1 ± 9.9 CRP (mg/L) 8.3 ± 3.5 8.3 ± 9.8 8.6 ± 5.8 7.1 ± 6.1 8.3 ± 5.9 10.6 ± 10.9 14.5 ± 15.5 15.5 ± 21.1 19.3 ± 8.6 Albumin (g/L) 38.0 ± 7.0 38.2 ± 8.3 38.7 ± 2.1 38.3 ± 6.8 38.1 ± 7.6 37.7 ± 7.4 37.3 ± 8.2 36.1 ± 9.6 37.0 ± 8.6 Ferritin (mg/L) 701 ± 777 365 ± 324 – – – 584 ± 412 – – 736 ± 590 TS (%) 31.3 ± 11.4 29.9 ± 12.4 31.8 ± 8.4 31.1 ± 9.8 29.0 ± 7.6 28.2 ± 12.2 31.5 ± 11.9 27.2 ± 13.0 27.4 ± 11.0 Creatinine (mmol/L) 1.046 ± 275 879 ± 283 985 ± 322 892 ± 206 929 ± 319 859 ± 309 997 ± 328 870 ± 300 860 ± 283 Group B Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Hb (g/L) 110.7 ± 4.5 111.3 ± 2.9 111.3 ± 3.2 113.7 ± 7.2 116.7 ± 2.9 125.7 ± 7.2 120.3 ± 0.6 122.0 ± 14.1 120.7 ± 9.1 EPO/week (IU/week ) 8 333 ± 3 512 8 333 ± 3 512 9 667 ± 4 041 11 667 ± 6 506 12 667 ± 6 807 10 667 ± 5 132 10 667 ± 5 132 8 667 ± 5 508 10 400 ± 5 048 EPO/week/bw (IU/week/kg) 117.1 ± 51.5 117.1 ± 51.5 134.4 ± 53.5 163.1 ± 94.4 177.3 ± 97.3 148.8 ± 66.6 148.8 ± 66.6 124.8 ± 85.9 151.0 ± 76.6 ERI (IU/week/kg/g/dL) 10.5 ± 4.4 12.2 ± 5.1 14.7 ± 9.0 15.3 ± 8.6 11.8 ± 5.3 12.4 ± 5.5 10.8 ± 8.7 12.8 ± 6.9 10.5 ± 4.2 CRP (mg/L) 8.0 ± 7.1 – 11.5 ± 12.0 7.0 ± 6.1 – 5.0 ± 3.5 – – 5.7 ± 3.1 Albumin (g/L) 42.7 ± 4.5 – – 43.7 ± 3.2 – 42.0 ± 1.0 – – 42.0 ± 2.0 Ferritin (mg/L) 461 ± 121 – – 549 ± 146 – 597 ± 237 – – 708 ± 248 TS (%) 29.0 ± 15.5 – – 23.3 ± 10.1 – 27.0 ± 9.5 – – 26.0 ± 5.6 Creatinine (mmol/L) – 1.067 ± 103 – – 1.091 ± 62 – 1.100 ± 46 – 1.038 ± 30 Conclusion Our study showed that chronic hemodialysis patients with a failed kidney transplant still in place had increased erythropoietin requirements. They exhibited higher erythropoietin resistance with worse anemia and worse biochemical parameters characteristic of chronic inflammatory state compared to chronic hemodialysis patients after a failed transplant nephrectomy.