Assessment of Erythropoietin Levels and Some Iron Indices in Chronic Renal Failure and Liver Cirrhosis Patients

Abstract

This study was constructed to investigate the relationship between renal anaemia and erythropoietin (EPO) concentrations in chronic renal failure (CRF) patients and to evaluate the possible role of the liver. Serum EPO levels were measured in blood samples from 20 CRF patients on hemodialysis (HD), 20 liver cirrhosis (LC) patients, 20 patients having both CRF and LC and undergoing HD, and 20 normal control subjects. Blood cell counts, iron indices (iron, total iron-binding capacity (TIBC) and ferritin), renal function (blood urea nitrogen (BUN) and creatinine), hepatic function (ALT, AST, ALP and bilirubin) investigations were carried out for all the subjects enrolled in this study. CRF patients without LC had serum EPO concentration of 6.21 ± 0.53 mU/ml (mean ± SE), which was significantly higher than that in patients having both CRF and LC (4.32 ± 0.52) (p < 0.01). Both groups showed significantly lower values than the controls (12.75 ± 0.70) (p < 0.001). LC patients with intact kidneys had significantly higher EPO level (22.70 ± 1.70) (p < 0.001). No correlation was found between EPO level and any of the hematologic or iron indices.

Analysis of factors contributing to higher erythropoietin levels in patients with chronic liver disease

“…This study aimed to elucidate potential factors influencing EPO levels in chronic liver disease. In accordance with previous studies (15)(16)(17), we found elevated EPO levels in patients with chronic liver disease compared with healthy controls. In our study, the increase of plasma EPO levels correlated predominantly with the degree of anaemia and with the degree of liver dysfunction.…”

“…Previous studies have reported that the anaemia in patients with liver cirrhosis is accompanied by an upregulation of EPO levels (15)(16)(17)(18). However, it is unclear whether the low haemoglobin is the only relevant factor for EPO regulation in liver diseases.…”

Plasma erythropoietin levels in anaemic and non-anaemic patients with chronic liver diseases

“…This was in part conflicting with the findings of other authors [12,13,15] and suggested that liver damage itself, independent of the degree of dysfunction, was not able to alter circulating Epo levels.…”

“…Papers regarding abnormalities of circulating Epo in patients with liver diseases were few and results were contradictory [11][12][13][14][15][16][17][18] . Some authors have reported higher Epo levels in cirrhotic patients when compared to healthy controls.…”

“…Some studies regarding the association between Epo levels and cirrhosis have appeared in literature [11][12][13][14][15][16] but reported data are controversial.…”