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Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis.
J Nephrol. 2003 Sep-Oct; 16(5):697-702.JN

Abstract

BACKGROUND

The management of anemia with erythropoietin (EPO) is important in the global treatment of dialysis patients. There is a general impression that anemia control with EPO is obtained more easily in peritoneal dialysis (PD) patients than in hemodialysis (HD) patients. The EPO administration route has to be the same to compare the two techniques adequately.

METHODS

To compare EPO action by subcutaneous (SC) route in HD and PD, 132 stable patients were recruited (HD: 69, PD: 63) from six centers, with adequate dialysis criteria (Kt/V in HD >1.3; weekly Kt/V in PD >1.8). In a cross-sectional study, the EPO dose/week, the number of EPO doses/week, hemoglobin (Hb), ferritin, transferrin saturation index (TS), albumin and intact parathyroid hormone (iPTH) were analyzed. Iron treatment, comorbidity and ACE inhibitors (ACEI) and angiotensin II antagonist (AIIA) treatment were recorded. A multivariate regression model was used in the statistical analysis.

RESULTS

The mean Hb level was the same in both groups, HD 11.6 (1.3) g/dL, PD 11.4 (1.4) g/dL, p=0.3. The SC, EPO doses required to obtain the Hb levels were higher in HD than in PD patients, with a difference of 64.3 u/Kg/week, statistically significant in the multivariate regression model (p=0.001, 95% CI 42.6-86.0). The number of EPO doses/week was also higher in HD patients (65% of HD patients with > or = 3 doses, 19% of PD patients with three or more doses, p<0.001). TS was similar in both groups, while ferritin was higher in HD patients, with a higher percentage of HD patients using intravenous (i.v.) iron (HD 77% vs. PD 49%, p=0.001). Serum albumin and iPTH were lower in PD patients (p<0.001 and p=0.04, respectively), but the percentage of patients with intact parathyroid hormone (iPTH) >500 pg/mL was similar in both groups (HD 17%, PD 14%).

CONCLUSIONS

With the same administration route, PD patients showed a reduced EPO requirement, and less frequent EPO administration than HD patients, to obtain the same Hb level. No other factors, except those involved in better depuration of erythropoiesis inhibitors in PD, seemed responsible for the different EPO requirements.

Authors+Show Affiliations

Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain. fcoronel.hcsc@salud.madrid.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

14733416

Citation

Coronel, Francisco, et al. "Erythropoietin Requirements: a Comparative Multicenter Study Between Peritoneal Dialysis and Hemodialysis." Journal of Nephrology, vol. 16, no. 5, 2003, pp. 697-702.
Coronel F, Herrero JA, Montenegro J, et al. Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis. J Nephrol. 2003;16(5):697-702.
Coronel, F., Herrero, J. A., Montenegro, J., Fernandez, C., Gandara, A., Conesa, J., Rivera, M. T., Torrente, J., Portolés, J., & Gomez-Martino, J. R. (2003). Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis. Journal of Nephrology, 16(5), 697-702.
Coronel F, et al. Erythropoietin Requirements: a Comparative Multicenter Study Between Peritoneal Dialysis and Hemodialysis. J Nephrol. 2003 Sep-Oct;16(5):697-702. PubMed PMID: 14733416.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis. AU - Coronel,Francisco, AU - Herrero,Jose A, AU - Montenegro,Jesus, AU - Fernandez,Cristina, AU - Gandara,Argimiro, AU - Conesa,Jose, AU - Rivera,M Teresa, AU - Torrente,Jaime, AU - Portolés,Jose, AU - Gomez-Martino,Juan R, PY - 2004/1/22/pubmed PY - 2004/3/5/medline PY - 2004/1/22/entrez SP - 697 EP - 702 JF - Journal of nephrology JO - J Nephrol VL - 16 IS - 5 N2 - BACKGROUND: The management of anemia with erythropoietin (EPO) is important in the global treatment of dialysis patients. There is a general impression that anemia control with EPO is obtained more easily in peritoneal dialysis (PD) patients than in hemodialysis (HD) patients. The EPO administration route has to be the same to compare the two techniques adequately. METHODS: To compare EPO action by subcutaneous (SC) route in HD and PD, 132 stable patients were recruited (HD: 69, PD: 63) from six centers, with adequate dialysis criteria (Kt/V in HD >1.3; weekly Kt/V in PD >1.8). In a cross-sectional study, the EPO dose/week, the number of EPO doses/week, hemoglobin (Hb), ferritin, transferrin saturation index (TS), albumin and intact parathyroid hormone (iPTH) were analyzed. Iron treatment, comorbidity and ACE inhibitors (ACEI) and angiotensin II antagonist (AIIA) treatment were recorded. A multivariate regression model was used in the statistical analysis. RESULTS: The mean Hb level was the same in both groups, HD 11.6 (1.3) g/dL, PD 11.4 (1.4) g/dL, p=0.3. The SC, EPO doses required to obtain the Hb levels were higher in HD than in PD patients, with a difference of 64.3 u/Kg/week, statistically significant in the multivariate regression model (p=0.001, 95% CI 42.6-86.0). The number of EPO doses/week was also higher in HD patients (65% of HD patients with > or = 3 doses, 19% of PD patients with three or more doses, p<0.001). TS was similar in both groups, while ferritin was higher in HD patients, with a higher percentage of HD patients using intravenous (i.v.) iron (HD 77% vs. PD 49%, p=0.001). Serum albumin and iPTH were lower in PD patients (p<0.001 and p=0.04, respectively), but the percentage of patients with intact parathyroid hormone (iPTH) >500 pg/mL was similar in both groups (HD 17%, PD 14%). CONCLUSIONS: With the same administration route, PD patients showed a reduced EPO requirement, and less frequent EPO administration than HD patients, to obtain the same Hb level. No other factors, except those involved in better depuration of erythropoiesis inhibitors in PD, seemed responsible for the different EPO requirements. SN - 1121-8428 UR - https://www.unboundmedicine.com/medline/citation/14733416/Erythropoietin_requirements:_a_comparative_multicenter_study_between_peritoneal_dialysis_and_hemodialysis_ L2 - https://medlineplus.gov/dialysis.html DB - PRIME DP - Unbound Medicine ER -