Hepatitis B virus infection and the response to erythropoietin in end-stage renal disease

In patients with end-stage renal disease (ESRD), viral or bacterial infecti ons are postulated to abolish or impair response to recombinant erythropoie tin (Epogen). However, previous reports revealed that response to Epogen am ong hemodialysis patients with a particular viral infection-human immunodef iciency virus (HIV)-seems to be variable and is independent of illness seve rity. To further explore the issue of response to Epogen in hemodialysis pa tients with viral infection, we retrospectively studied four patients with hepatitis B virus infection over a 3 month period to compare their response to Epogen and endogenous erythropoietin levels with those of a control gro up of patients without hepatitis B virus infection. Weekly predialysis hematocrit, and monthly serum albumin concentration, tra nsferrin saturation as well as percent reduction of urea were obtained from patient records, and mean values were calculated for each subject. Mean ag e of the patients (n = 4) was 63 +/- 7.5 years compared with 55 +/- 23 year s for the control subjects (n = 4)(p = 0.02). The mean hematocrit of the st udy patients was 33.7 +/- 2.8% compared with 34.7 +/- 4.9% in the control s ubjects (p = 0.49), and the mean endogenous erythropoietin level in the stu dy patients was 27 +/- 22 mIU/ml compared with 5.7 +/- 1.9 mIU/ml in the co ntrol group (p = 0.001). The mean dose of thrice weekly Epogen, both at ons et of the study and when endogenous erythropoietin was measured, was 61 +/- 19 U/kg body weight in the patients, compared with 74 +/- 8 U/kg body weig ht in the control subjects (p = 0.002). We conclude that patients with ESRD and hepatitis B surface antigenemia respond to Epogen as well as their cou nterparts without hepatitis B virus infection. in addition, patients with h epatitis B surface antigenemia have much higher serum levels of endogenous erythropoietin and require less exogenous erythropoietin injections than th eir counterparts.