THE METABOLISM OF ERYTHROPOIETIN IN LIVER-CIRRHOSIS PATIENTS COMPAREDWITH HEALTHY-VOLUNTEERS

The purpose of the investigation was to study the metabolism of erythr opoietin (EPO) in patients with liver disease. Twelve patients with li ver cirrhosis and 10 healthy volunteers were studied. The patients wer e moderately anemic with a hematocrit of 33 vs 42% (medians) in the vo lunteers. The pharmacokinetic parameters were calculated after an intr avenous (i.v.) injection of 100 U/kg of recombinant human EPO. The ser um EPO was measured by radioimmunoassay at regular intervals until 48 h. The median terminal elimination half life in the cirrhosis patients was 5.15 h vs 5.37 h in the control subjects. The clearance was 7.78 vs 7.52 ml/min/1.73 m(2) (ns). The steady-state volume of distribution was 3.69 vs 3.09 l/1.73 m(2) (ns). The estimated endogenous EPO produ ction was significantly higher in liver cirrhosis (486 vs 290 U/d/1.73 m(2), p < 0.01). The basal serum EPO was significantly higher in the c irrhosis patients (43.5 vs 26.3 U/l, p < 0.01). The hematocrit correla ted inversely with the basal serum EPO level in the cirrhosis patients (r = - 0.63, p < 0.04). The EPO-clearance was not related to the pres ence of ascites, esophageal varices, or to abnormal blood chemistry. I t was concluded that normal metabolism of EPO was maintained in liver cirrhosis and that the cirrhotic patients had a moderate compensatory increase of EPO production in response to anemia.