Document Detail

CMV seropositivity determines epoetin dose and hemoglobin levels in patients with CKD.
MedLine Citation:
PMID:  19820127     Owner:  NLM     Status:  MEDLINE    
Cytomegalovirus (CMV)-seropositive patients with ESRD may have more CD4(+) T cells lacking the co-stimulatory molecule CD28 (CD4(+)CD28null) than CMV-seronegative patients. Increased numbers of CD28null T cells associates with epoetin nonresponsiveness in patients with ESRD, but whether expansion of CD4+CD28null T cells in CMV-seropositive patients associates with demand for epoetin is unknown. In a cohort of 129 stable patients with ESRD, CMV seropositivity significantly associated with a lower hemoglobin level in predialysis patients (12.5 versus 11.5 g/dl; P < 0.02). CMV seropositivity did not associate with average hemoglobin level in hemodialysis patients, but CMV-seropositive patients required significantly more epoetin (median 12,000 versus 6300 U/wk; P = 0.02). Multivariate linear regression analysis identified CMV seropositivity as the only variable significantly associated with hemoglobin levels in predialysis patients and epoetin dosages in hemodialysis patients. In CMV-seropositive hemodialysis patients, the number of circulating CD4(+)CD28null T cells positively correlated with epoetin dosage. These CD4(+)CD28null T cells were proinflammatory; they were capable of producing large amounts of IFN-gamma and TNF-alpha. In conclusion, expansion of CD4(+)CD28null T cells in CMV-seropositive patients with ESRD associates with increased demand for epoetin.
Michiel G H Betjes; Willem Weimar; Nicolle H R Litjens
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-10-09
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  20     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-01     Completed Date:  2009-12-29     Revised Date:  2013-06-03    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2661-6     Citation Subset:  IM    
Erasmus Medical Center, Department of Internal Medicine, Division of Nephrology, Dr. Molewaterplein 40, Rotterdam, Netherlands.
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MeSH Terms
Antibodies, Viral / blood
Antigens, CD28 / metabolism
CD4-Positive T-Lymphocytes / immunology
Cohort Studies
Cytomegalovirus / immunology
Cytomegalovirus Infections / complications*,  immunology
Dose-Response Relationship, Drug
Erythropoietin / administration & dosage*,  analogs & derivatives*
Hemoglobins / metabolism*
Interferon-gamma / biosynthesis
Kidney Failure, Chronic / blood,  complications*,  drug therapy*,  immunology
Middle Aged
Recombinant Proteins
Renal Dialysis
T-Lymphocyte Subsets / immunology
Tumor Necrosis Factor-alpha / biosynthesis
Reg. No./Substance:
0/Antibodies, Viral; 0/Antigens, CD28; 0/Hemoglobins; 0/Recombinant Proteins; 0/Tumor Necrosis Factor-alpha; 0/epoetin beta; 11096-26-7/Erythropoietin; 15UQ94PT4P/darbepoetin alfa; 82115-62-6/Interferon-gamma

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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