The effect of total nephrectomy on hematopoiesis in patients undergoing chronic hemodialysis.

Abstract

Abstract Routine hematologic measurements, erythrokinetic studies, and serum erythropoietic-stimulating factor (ESF) assays were perforMed before and after bilateral nephrectomy in 8 patients undergoing chronic hemodialysis. In addition, average hematocrit values and transfusion requirements were determined on these and 19 other patients prior to and after removal of the kidneys. The results indicate that hematocrit values decrease and transfusion requirements increase after the kidneys are removed, even though the patients had severe renal failure requiring regular dialysis prior to surgery, and the level of azotemia did not change. These findings are accompanied by decreased total and erythroid iron utilization. Red cell survival times, while shorter than normal, were not changed significantly. ESF was not detectable in the plasma of any patient prior to nephrectomy, but was detectable in 1 patient after the kidneys were removed when the hematocrit reached a very low level. These findings suggest that bilateral nephrectomy so adversely affects erythropoiesis that the procedure should be recommended only for control of severe hypertension, for other specific indications, or at the time of renal transplantation.