High-flux polysulfone improves the response to recombinant human erythropoietin (RH-EPO) in patients on long term hemodialysis (HD)

High-flux and biocompatible dialyzers may have a positive effect on anemia in rh-EPO-treated HD patients. This increase in the efficiency of rh-EPO ma y be mediated either by a decrease-in production of pro-inflammatory cytoki nes or by better clearance of middle and large toxic uremic molecules. In a previous report a switch from a low-permeability ad non-biocompatible dial ysis membrane to a high-permeability, biocompatible membrane and more effic ient dialysis improved the response to rh-EPO. In this study 31 stable patients on HD were switched from a cellulosic dial yzer to a high-flux polysulfone dialyzer (PSF). Patients were studied for 4 months before and 8 months after the change of dialyzer, During these peri ods there was no change in other parameters of HD including Kt.V. Another 1 6 similar patients on HD were studied as a control group. During the study was maintained a target hematocrit of about 35% changing the rh-EPO dose if neccesary. The rh-EPO dose and dose/kg decreased significantly in the stud y group when cellulosic membranes were replaced by PSF. In the control grou p rh-EPO dose did not change; Neither hematocrit nor Hb changed significant ly during follow-up. Blood ferritin levels increased and intravenous iron s upplementation dose decreased in the study group during PSF period while th e MCV increased. Conclusion: The swith from cellulosic to PSF membrane, without any change i n the dialysis dose improved the response to rh-EPO by about 14% in patient s with a target hematocrit of 35% on HD. This improvement is accompanied by a better functional availability of iron.