THE EFFECT OF RECOMBINANT-HUMAN-ERYTHROPOIETIN ON HEMATOPOIESIS IN PATIENTS UNDERGOING HEMODIALYSIS

Objective. To define the effect of intravenous recombinant human eryth ropoietin (rHuEPO) in patients with anaemia caused by chronic renal fa ilure. Data collection included bone marrow response, ferrokinetics, r ed cell survival as well as the influence on red cell mass and plasma volume. Design. A convenience sample of stable individuals on haemodia lysis, with haemoglobin (Hb) levels of less than 80 g/l, was surveyed over a 12-week period while they were receiving the hormone. Blood cou nts and iron studies were monitored serially, while Cr-51-labelled red cells and Fe-59 (III) citrate were used in the radionuclide investiga tions carried out before and after the course of replacement therapy w as completed (pre and post injection). Bone marrow aspiration and trep hine biopsy were performed at each of these times. Results. The actual mean trial period was 14 weeks. Eight patients were enrolled but 1 wa s withdrawn after developing tuberculosis at the start of the study. H aemoglobin levels rose from 59 g/l (SD 8.8) to 96 g/l (SD 13.9) (P < 0 .0001); mean red cell mass rose from 675 ml to 954 ml (P < 0.01). Conc urrently, the serial studies in 6 patients showed prominent erythroid hyperplasia. Plasma iron turnover increased insignificantly from 42.5 to 118.9 mu mol/l/day; erythron turnover increased from 42.5 to 87.3 m u mol/l/day (P < 0.01). There was a marked shortening of the marrow tr ansit time from 4.4 to 3.3 days (P < 0.03). Efficacy of erythropoiesis decreased from 1.17 to 0.65 (P < 0.05). Red cell survival was not alt ered. Conclusions. The patient with end-stage renal failure remains fu lly responsive to erythropoietin therapy. This is reflected in improve d ferrokinetics, red cell hyperplasia in the marrow and rise in haemog lobin level without alteration in mean erythrocyte lifespan, Simple ho rmonal replacement is therefore a rational approach to management.