INCREASED RESPONSE TO SUBCUTANEOUS ERYTHROPOIETIN ON TYPE-I DIABETIC-PATIENTS ON CAPD - IS THERE A SYNERGISTIC EFFECT WITH INSULIN

Objective: To evaluate the effect of subcutaneous erythropoietin (SC E PO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Design: A resistance i ndex was designed for measuring the relative EPO response, dividing EP O dose (U/kg/week) week) by the hemoglobin (Hb) increment with respect to the basal level. Patients: Eleven nonselected type I diabetic pati ents using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy. Results: The two groups showed similar mean base line hemoglobin levels (7.4 D-l and 7.7 non-D, g/dL). There was a stat istically significant lower resistance index for diabetics (13.8+/-9.7 U/kg/g Hb increment) compared to nondiabetic (55.8+/-128, p < 0.001). Multivariate analysis confirmed an independent association between di abetes and resistance index. The response to EPO was slightly better a mong those diabetic patients with lower levels of serum parathyroid ho rmone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p < 0.05). No other differences, apart from the use of subcutaneous in sulin, were found between diabetics and controls. Although diabetic pa tients had an increased response to EPO, they had no more frequent sid e effects than nondiabetics. Conclusions: According to our results, we suggest that factorsrelated to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived f rom subcutaneous use of insulin might act as a comitogen with the indu ced increments of serum erythropoietin.