| Timing and Determinants of Erythropoietin Deficiency in Chronic Kidney Disease. | |
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MedLine Citation:
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PMID: 22096037 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background and objectivesAnemia in patients with CKD is highly related to impaired erythropoietin (EPO) response, the timing and determinants of which remain unknown.Design, setting, participants, & measurementsThis study measured EPO levels and studied their relation to GFR measured by 51Cr-EDTA renal clearance (mGFR) in 336 all-stage CKD patients not receiving any erythropoiesis-stimulating agent.ResultsIn patients with anemia defined by World Health Organization criteria (hemoglobin [Hb] <13 g/dl in men and 12 g/dl in women), EPO response to Hb level varied by mGFR level. EPO and Hb levels were negatively correlated (r=-0.22, P=0.04) when mGFR was >30 ml/min per 1.73 m(2), whereas they were not correlated when mGFR was <30 (r=0.09, P=0.3; P for interaction=0.01). In patients with anemia, the ratio of observed EPO to the level predicted by the equation for their Hb level decreased from 0.72 (interquartile range, 0.57-0.95) for mGFR ≥60 ml/min per 1.73 m(2) to 0.36 (interquartile range, 0.16-0.69) for mGFR <15. Obesity, diabetes with nephropathy other than diabetic glomerulopathy, absolute iron deficiency, and high C-reactive protein concentrations were associated with increased EPO levels, independent of Hb and mGFR.ConclusionsAnemia in CKD is marked by an early relative EPO deficiency, but several factors besides Hb may persistently stimulate EPO synthesis. Although EPO deficiency is likely the main determinant of anemia in patients with advanced CKD, the presence of anemia in those with mGFR >30 ml/min per 1.73 m(2) calls for other explanatory factors. |
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Authors:
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Lucile Mercadal; Marie Metzger; Nicole Casadevall; Jean Philippe Haymann; Alexandre Karras; Jean-Jacques Boffa; Martin Flamant; François Vrtovsnik; Bénédicte Stengel; Marc Froissart; |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-17 |
Journal Detail:
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Title: Clinical journal of the American Society of Nephrology : CJASN Volume: - ISSN: 1555-905X ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-18 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101271570 Medline TA: Clin J Am Soc Nephrol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney Diseases Team, Villejuif, France; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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