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      Recombinant Human Erythropoietin Resistance in Iron-Replete Hemodialysis Patients: Role of Aluminum Toxicity

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          Abstract

          The present study was designed to investigate the impact of aluminum toxicity on the response to recombinant human erythropoietin (rHuEPO) therapy in hemodialysis patients, when iron deficiency has been corrected or excluded. We studied 39 patients on regular hemodialysis (20 males and 19 females; mean age 58.8 years), who were under maintenance rHuEPO treatment for at least 6 months, and who had stable hematocrit levels for more than 3 months. All patients had adequate iron stores and availability with serum ferritin >100 µg/l and iron saturation >25%. They were classified into two groups: 19 poor responders, who required subcutaneous rHuEPO doses >100 U/kg/week and failed to achieve the target hematocrit level of 30%, and 20 good responders, who needed doses of ≤100 U/kg/week to maintain the target level. Serum aluminum levels including basal (Al<sub>basal</sub>) and 44 h after desferrioxamine (DFO) infusion (Al<sub>post-DFO</sub>), intact parathyroid hormone, and inflammatory and hemolytic indices were examined in both groups. The results showed that the mean weekly rHuEPO doses were significantly lower and the mean hematocrit levels higher in the good responders than in the poor responders. Although the poor responders had markedly higher mean Al<sub>basal</sub> and Al<sub>post-DFO</sub> levels, no differences were observed in the other parameters between the two groups. Furthermore, the poor responders significantly had the greater increment in the serum aluminum levels after DFO infusion (ΔAl =Al<sub>post-DFO</sub> – Al<sub>basal</sub>). The mean corpuscular volume had a strong inverse correlation with ΔAl in the poor response group (r = –0.711, p < 0.001). We concluded that the post-DFO rise of serum aluminum can be used as a means of estimating tissue stores. Subclinical aluminum toxicity may exhibit an inhibitory effect on erythropoietic response to rHuEPO therapy.

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          Erythropoietin, aluminium, and anaemia in patients on haemodialysis

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            Author and article information

            Journal
            AJN
            Am J Nephrol
            10.1159/issn.0250-8095
            American Journal of Nephrology
            S. Karger AG
            0250-8095
            1421-9670
            1998
            February 1998
            16 January 1998
            : 18
            : 1
            : 1-8
            Affiliations
            Division of Nephrology, Department of Medicine, Veterans General Hospital-Taipei, and National Yang-Ming University, Taipei, Taiwan/ROC
            Article
            13297 Am J Nephrol 1998;18:1–8
            10.1159/000013297
            9481432
            © 1998 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
            Figures: 4, Tables: 3, References: 30, Pages: 8
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/13297
            Categories
            Clinical Study

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