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      No Acute Change of Serum Erythropoietin in Response to Hypocalcemia or Antihypertensive Agents in Uremic Patients

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          Abstract

          Endogenous erythropoietin (EPO) secretion can still be modulated in patients with end-stage renal failure but only in response to strong stimuli. Thus even anephric dialysis patients are able to increase EPO production acutely when exposed to a marked hypoxic stimulus. The present study was designed to test the hypothesis that a decrease of plasma calcium or the administration of various antihypertensive agents might be able to induce acute changes of plasma EPO concentration. Four groups of chronic hemodialysis patients were studied. Eight patients volunteered for the induction of an acute, transient hypocalcemia via a calcium-free dialysate during the initial 60 min of a regular dialysis session of 240 min. Plasma immunoreactive (i) EPO, total calcium, and intact parathyroid hormone (iPTH<sub>1-84</sub>), as well as blood ionized calcium and blood gases were measured before as well as 30, 60,120 and 240 min after the start of dialysis. In addition, plasma iEPO was measured 48 h after the session. Patients of group 2 (n = 6), group 3 (n = 6), and group 4 (n = 7) received the day after a hemodialysis session a single dose of either acetazolamide, furosemide, or enalapril, respectively, and their plasma iEPO was determined before and 3, 6 and/or 24 h after drug administration. In group 1, plasma total calcium decreased from 2.39 ± 0.07 m M(mean ± SEM) to 1.98 ± 0.02 and 1.83 ± 0.03 m M after 30 and 60 min of dialysis, respectively, and blood ionized calcium from 1.28 ± 0.04 to 1.02 ± 0.03 and 0.92 ± 0.04 m M, respectively. Circulating iPTH rose from a basal value of 96 ± 27 pg/ml to 431 ± 154 and 374 ± 156 pg/ml at 30 and 60 min, respectively. Plasma iEPO levels were however unchanged during the 60 min of calcium-free dialysis and thereafter (21.8 ± 1.2 vs. 21.8 ± 1.3 mU/ml at 0 and 60 min, respectively), as were blood gases and pH. After the administration of hypertensive agents, there was also no acute change of plasma iEPO except for furosemide (group 3) where a borderline decrease of plasma iEPO was observed after 6 h (from initially 51.6 ± 11.6 to 31.4 ± 4.3 mU/ml, p < 0.06). In conclusion, neither the induction of hypocalcemia nor the administration of antihypertensive agents lead to acute changes of plasma iEPO levels in chronic hemodialysis patients.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1995
          1995
          18 December 2008
          : 70
          : 2
          : 197-201
          Affiliations
          aDépartement de Néphrologie et Unité 90 de l’INSERM, Hôpital Necker-Enfants Malades, Paris, bService de Néphrologie et d’Hémodialyse, Hôpital St. Cloud, France; cPhysiologisches Institut I der Universität Regensburg, Germany
          Article
          188583 Nephron 1995;70:197–201
          10.1159/000188583
          7566303
          © 1995 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 5
          Categories
          Original Paper

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