Erythrocytosis in Patients on Long-term Hemodialysis

Shalhoub, Robert J.; Rajan, Uma; Kim, Vo V.; Goldwasser, Eugene; Kark, John A.; Antoniou, Lucy D.

doi:10.7326/0003-4819-97-5-686

Cited by 64 publications

(30 citation statements)

References 24 publications

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“…10 Individual cases of erythrocytosis associated with ACKD have been reported since 1982. 11 Studies assessing a link between cyst extent and higher hematocrits among HD patients have reported contradictory findings, however. 12, 13 Kuo et al 3 performed a number of diagnostic tests on their 21 patients who evidenced ESA independence and also on 43 ageand sex-matched HD patients, including renal ultrasonography to evaluate cyst formation, because hemoglobin level strongly correlated with HD duration in their study.…”

Section: Discussionmentioning

confidence: 99%

Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

Goodkin

Fuller

Robinson

et al. 2011

Journal of the American Society of Nephrology

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A small percentage of hemodialysis patients maintain higher hemoglobin concentrations without transfusion or erythropoietic therapy. Because uncertainty exists regarding the effects of higher hemoglobin concentration on mortality and quality of life among hemodialysis patients, studying this group of patients with sufficient endogenous erythropoietin may provide additional insights. The prospective, observational Dialysis Outcomes and Practice Patterns Study provides an opportunity to investigate this group. Among 29,796 patients in 12 nations, 545 (1.8%) maintained hemoglobin concentrations Ͼ12 g/dl for 4 months without erythropoietic support. This subset tended to be male, to have a longer duration of end-stage renal disease, and to not dialyze via a catheter. Cystic disease as the underlying cause of renal failure was over-represented in this group but was present in only 25%. Lung disease, smoking, and cardiovascular disease were associated with increased likelihood of naturally higher hemoglobin concentration. Quality-of-life scores were not higher among this subset compared with the other patients. Unadjusted mortality risk for patients with hemoglobin Ͼ12 g/dl and no erythropoietic therapy was lower than for the other patients, but after thorough adjustment for case mix, there was no difference between groups (relative risk, 0.98; 95% CI 0.80 to 1.19). These data show that naturally occurring hemoglobin concentration Ͼ12 g/dl does not associate with increased mortality among hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

Goodkin

Fuller

Robinson

et al. 2011

Journal of the American Society of Nephrology

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“…Without recombinant human erythropoietin (rhEPO) therapy, most uremic patients had moderate to severe anemia, except those with polycystic kidney disease [2]. Erythrocytosis had been rarely reported in patients with chronic renal failure undergoing regular dialysis therapy [3, 4, 5, 6, 7, 8, 9, 10, 11]. Of the reported cases, polycythemia vera (PV) had only been described in 4 patients [7, 8, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

End-Stage Renal Disease following Polycythemia vera: In vitro and in vivo Response of Erythroid Progenitors to Erythropoietin and Effects of Sera on Normal Erythropoiesis

Shih

Huang²

1998

Nephron

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We investigated the in vitro erythroid progenitor growth and the effects of sera on normal-marrow CFU-E (colony-forming units – erythroid) growth in 2 patients with renal failure on regular hemodialysis following a prior history of polycythemia vera (PV). PV was diagnosed 3 and 11 years, respectively, before the development of terminal renal failure. One of the patients had entered a spent phase of PV as characterized by diffuse extensive myelofibrosis and anemia; the other also had mild myelofibrosis. The serum erythropoietin (EPO) levels were low or normal on serial measurements by radioimmunoassay. There was no correlation between the hematocrit values and serum EPO levels. EPO-independent erythroid colonies were present in the cultures of bone marrow and peripheral blood cells from both patients after renal failure in the anemic state. With the addition of various concentrations of EPO, the number of erythroid colonies increased as the concentrations of EPO increased which was in accordance with the clinical observation that 1 patient with postpolycythemic myeloid metaplasia partially responded to recombinant human EPO therapy. In the EPO-dependent CFU-E assay, normal-marrow CFU-E numbers supported by 10% of the patient sera were less than those by normal sera. In the absence of EPO in cultures, no erythropoietic activity was found in the patients’ sera. Our study on uremic patients with underlying PV showed that the biologic characteristics of autonomous erythroid progenitor growth for PV persisted during the spent phase and after the development of terminal renal failure with anemia. The erythroid progenitors responded to EPO both in vitro and in vivo. Their sera exhibited an inhibiting effect on the growth of normal-marrow erythroid progenitors.

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Section: The Role Of Epo Deficiency In the Pathogenesis Of Renal Anaemiamentioning

confidence: 99%

“…Some of those have cystic kidneys, either because of inherited polycystic kidney disease [90,9 I] or due to secondary cyst formation in the shrunken end-stage kidneys [92,93]. In both instances elevated EPO levels have been reported [90,93), but the mechanisms underlying this phenomenon remain unknown. In some patients an increase in erythropoiesis followed the onset of viral hepatitis [94,95] and this may result from an enhanced hepatic EPO production that has also been found experimentally in association with hepatic proliferation [96,97J.…”

Section: The Role Of Epo Deficiency In the Pathogenesis Of Renal Anaemiamentioning

confidence: 99%

Erythropoietin in health and disease

Eckardt

Bauer

1989

Eur J Clin Investigation

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Erythrocytosis in Patients on Long-term Hemodialysis

Cited by 64 publications

References 24 publications

Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

End-Stage Renal Disease following Polycythemia vera: In vitro and in vivo Response of Erythroid Progenitors to Erythropoietin and Effects of Sera on Normal Erythropoiesis

Erythropoietin in health and disease

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