INCREASED ERYTHROPOIETIN REQUIREMENTS IN PATIENTS WITH FAILED RENAL-TRANSPLANTS RETURNING TO A DIALYSIS PROGRAM

The response to erythropoietin (Epo) is dose dependent but, for variou s poorly understood reasons, variable. In a cross-sectional study we d etermined the Epo requirement of 60 patients in a dialysis population to identify those patients requiring a high dose of Epo, and ascertain ed the reasons for higher requirements, paying particular attention to the effect of previous transplantation. All 289 patients attending a single centre were surveyed. Of these, 164 were receiving renal replac ement therapy by continuous ambulatory peritoneal dialysis (CAPD) and 125 were on haemodialysis (HD). Patients on HD needed more Epo than th ose on CAPD (129.0+/-14.9 U/kg/week versus 86.9+/-10.7 U/kg/week, P<0. 05). However, this difference was accounted for by a subgroup of patie nts who had a previously failed transplant. The Epo requirement in tho se patients on HD with a failed transplant was significantly greater t han those on HD who had never been transplanted (164.0+/-24.5 U/kg/wee k versus 96.6+/-11.9 U/kg/week, P<0.05). The seven patients who retain their transplanted kidney had the highest Epo requirement of all (213 .4+/-46.6 U/kg/week). These studies have shown that previous transplan tation is a significant determinant of Epo requirement upon return to dialysis. They also show that it is necessary to 'correct' for the eff ect of previous transplantation when investigating generally accepted determinants of Epo need. Interpretation of previously published studi es needs to take account of this.