Erythropoietin therapy improves graft patency with no increased incidence of thrombosis or thrombophlebitis

Background: Recombinant human erythropoietin (rHuEPO) for the treatment of severe anemia in patients with end-stage renal disease (ESRD) is suggested to improve rehabilitation and cognitive function. The criticism is the alle ged increase in the failure rate of arteriovenous (AV) access grafts and in the incidence of lower-extremity deep venous thrombophlebitis (DVT). This study addressed the longevity of AV grafts and the incidence of DVT. Study Design: We reviewed 481 consecutive patients with ESRD on dialysis wi th PTFE access grafts, including 173 consecutive patients who were receivin g rHuEPO and 308 who were not. rHuEPO was administered during dialysis titr ated against the hematocrit to achieve a level of 33% to 38%. The rHuEPO-ES RD group included 173 patients with a mean age of 58 years, including 54% w omen; 84% of the grafts were in the upper extremity. In the control group o f 308 patients, 57% were women. Diabetes and hypertension were controlled i n both groups. Results: Forty-five of 173 rHuEPO patients (26%) experienced graft thrombos is within 1 year. Among 88 episodes of thrombosis, 14 patients experienced multiple episodes. Primary patency was 8.9 months; secondary patency was 11 .2 months. In the control population, 95 of 308 patients (31%) experienced graft thrombosis; 27 patients had multiple episodes. Primary patency was 7. 8 months and secondary patency was 9.8 months. The hematocrit improved from a mean of 23% in the control group to 34% in the treated rHuEPO group. Two patients in the control group and one patient receiving rHuEPO experienced DVT in the lower extremity. Conclusions: Primary and secondary AV fistula patency rates were improved b y 10% with rHuEPO. rHuEPO did not increase DVT. (J Am Coll Surg 1998;187:61 6-619. (C) 1998 by the American College of Surgeons).