ERYTHROPOIETIN TREATMENT IN HEMODIALYSIS-PATIENTS WITH IRON OVERLOAD

Erythropoietic response to exogenously administered recombinant human erythropoietin (rHuEpo) was examined in 11 maintenance haemodialysis p atients with iron overload (IO). All had required numerous blood trans fusions earlier (> 12 units/year). Diagnosis of IO was established by high serum ferritin (SF) levels (> 1,100 mu g/l), high hepatic CT dens ity (> 70 Hounsfield units; HU) and excessive iron stores in bane marr ow aspirate (grade 6). None of the patients had osteitis fibrosa cysti ca, aluminium intoxication, haemoglobinopathy or haemochromatosis alle les (HLA A3, B7 and B14). All patients responded to rHuEpo treatment ( target haemoglobin level of 9-10 g/dl). None of the patients required iron supplementation or developed 'functional anaemia'. During 30 +/- 3 months of therapy, the initial maintenance dose of rHuEpo (103 +/- 1 2 units/kg/week) and median SF levels (2,250 mu g/l) fell (50 +/- 8 un its/kg/week and 1,060 mu g/l, respectively) (p = 0.0003 and 0.0007). T he initial and final rHuEpo doses correlated well with the respective SF levels (r = 0.89, p < 0.001). The maintenance dose of rHuEpo requir ed for patients with IO at the start of the treatment period was signi ficantly higher than that (50 +/- 5 units/kg/week) required by a contr ol group of patients with adequate iron stores (SF = 100-600 mu g/l) w ho were matched for age, sex and frequency of previous blood transfusi ons (p = 0.002). The findings suggested that excessive IO caused relat ive resistance to erythropoiesis on exogenous administration of rHuEpo and that iron supplementation was not warranted during rHuEpo therapy in those patients.