ASSOCIATION BETWEEN HUMAN RECOMBINANT EPO AND PERIPHERAL VASCULAR-DISEASE IN DIABETIC-PATIENTS RECEIVING PERITONEAL-DIALYSIS

Peripheral vascular disease is a serious and frequent problem in diabe tic patients. Since the beginning of the widespread use of erythropoie tin (EPO), we have noted an increase in peripheral vascular disease in diabetic patients receiving peritoneal dialysis and erythropoietin. T his prompted us to study the effects of erythropoietin on peripheral v ascular disease in patients receiving peritoneal dialysis, We retrospe ctively reviewed medical records of all diabetic patients in our progr am who received peritoneal dialysis from 1990 to 1996. Demographic and laboratory data as well as EPO use data were collected. Hospital days and occurrence of vascular events (defined as peripheral vascular sur gery, amputation, or recommendation of vascular surgery or amputation by a vascular surgeon) were determined for diabetic patients receiving peritoneal dialysis, Comparisons were made between those who received EPO and those who did not received EPO, as well as comparing vascular events in 28 patients who received peritoneal dialysis before and aft er beginning EPO, Patients who received erythropoietin were found to h ave a significantly shorter time to a first vascular event, a greater number of vascular events, and more hospital days associated with vasc ular disease than diabetic patients who did not receive erythropoietin . With multivariate analysis, significant risk factors for the develop ment of peripheral vascular disease in these patients were erythropoie tin use, erythropoietin dose, and smoking, Twenty-eight patients who i nitially performed peritoneal dialysis without receiving EPO, and late r received EPO, had a significant increase In vascular events, includi ng amputations only while receiving EPO, We found the use of erythropo ietin to be associated with peripheral vascular events in diabetic pat ients who receive peritoneal dialysis, Further investigation is warran ted, (C) 1998 by the National Kidney Foundation, Inc.