Tags

Type your tag names separated by a space and hit enter

Recombinant human erythropoietin resistance in hemodialysis. Effects of paired filtration dialysis.
ASAIO J. 1997 Sep-Oct; 43(5):M535-8.AJ

Abstract

A percentage of hemodialysis (HD) patients are resistant to recombinant human erythropoietin (rHuEPO), a phenomenon that occurs less frequently in patients dialyzed with biocompatible membranes (M) and in peritoneal dialysis. The authors evaluated the effects of paired filtration dialysis (PFD)--a dialysis technique based on the use of an emophan M in conjunction with a polysulphone M--on erythropoiesis in HD patients resistant to rHuEPO. Twelve HD patients with anemia resistant to long-term therapy with rHuEPO (200.24 U/kg body weight three times per week intravenously for 10.2 months) were studied. Patients had been treated for an average of 46.9 months with bicarbonate HD, using cuprophan M (Phase A) and, successively, for 12 months by PFD (Phase B). The following parameters were evaluated monthly: 1) hemoglobin and hematocrit values; 2) serum levels of erythropoietin (EPO); and 3) serum levels of interleukin (IL)-3, IL-6, IL-10, IL-1 beta, tumor necrosis factor alpha (TNF-alpha), and interferon gamma (IFN-gamma). At the end of Phase A and Phase B, patients underwent bone marrow biopsies to evaluate 1) bone marrow burst forming unit erythroid (BFU-E) and colony forming unit erythroid (CFU-E) proliferative capacity, and 2) bone marrow mononuclear cell EPO-receptor (EPO-R) number. During Phase B, there was a progressive rise in hematocrit and hemoglobin values, so that within the sixth month, the rHuEPO dose was reduced to 80 +/- 15 U/kg body weight three times per week. At the same time, an increase in serum IL-3, IL-6, and IL-10 levels was seen, whereas serum IL-1 beta, TNF-alpha, and IFN-gamma levels decreased. This was accompanied by a rise in BFU-E and CFU-E growth and in bone marrow mononuclear cell EPO-R number. During Phase B, after the dialysis session, serum EPO levels increased by about 30% in comparison with pre dialysis values, whereas during Phase A they decreased by about 14%. In HD patients, EPO resistance may caused either by absorption of rHuEPO to the cuprophan M, or an increased release of cytokines that inhibit erythropoiesis, such as IL-1 beta, TNF-alpha, and IFN-gamma, and to a decrease in stimulatory cytokines such as IL-3, IL-6, and IL-10. These negative phenomena are reversed by the use of biocompatible dialysis techniques such as PFD.

Authors+Show Affiliations

Nephrology, Dialysis and Transplantation Unit, St. Paul's Hospital, Savona, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

9360100

Citation

Carozzi, S, et al. "Recombinant Human Erythropoietin Resistance in Hemodialysis. Effects of Paired Filtration Dialysis." ASAIO Journal (American Society for Artificial Internal Organs : 1992), vol. 43, no. 5, 1997, pp. M535-8.
Carozzi S, Nasini MG, Santoni O, et al. Recombinant human erythropoietin resistance in hemodialysis. Effects of paired filtration dialysis. ASAIO J. 1997;43(5):M535-8.
Carozzi, S., Nasini, M. G., Santoni, O., Tirotta, A., & Sanna, A. (1997). Recombinant human erythropoietin resistance in hemodialysis. Effects of paired filtration dialysis. ASAIO Journal (American Society for Artificial Internal Organs : 1992), 43(5), M535-8.
Carozzi S, et al. Recombinant Human Erythropoietin Resistance in Hemodialysis. Effects of Paired Filtration Dialysis. ASAIO J. 1997 Sep-Oct;43(5):M535-8. PubMed PMID: 9360100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recombinant human erythropoietin resistance in hemodialysis. Effects of paired filtration dialysis. AU - Carozzi,S, AU - Nasini,M G, AU - Santoni,O, AU - Tirotta,A, AU - Sanna,A, PY - 1997/11/14/pubmed PY - 1997/11/14/medline PY - 1997/11/14/entrez SP - M535 EP - 8 JF - ASAIO journal (American Society for Artificial Internal Organs : 1992) JO - ASAIO J VL - 43 IS - 5 N2 - A percentage of hemodialysis (HD) patients are resistant to recombinant human erythropoietin (rHuEPO), a phenomenon that occurs less frequently in patients dialyzed with biocompatible membranes (M) and in peritoneal dialysis. The authors evaluated the effects of paired filtration dialysis (PFD)--a dialysis technique based on the use of an emophan M in conjunction with a polysulphone M--on erythropoiesis in HD patients resistant to rHuEPO. Twelve HD patients with anemia resistant to long-term therapy with rHuEPO (200.24 U/kg body weight three times per week intravenously for 10.2 months) were studied. Patients had been treated for an average of 46.9 months with bicarbonate HD, using cuprophan M (Phase A) and, successively, for 12 months by PFD (Phase B). The following parameters were evaluated monthly: 1) hemoglobin and hematocrit values; 2) serum levels of erythropoietin (EPO); and 3) serum levels of interleukin (IL)-3, IL-6, IL-10, IL-1 beta, tumor necrosis factor alpha (TNF-alpha), and interferon gamma (IFN-gamma). At the end of Phase A and Phase B, patients underwent bone marrow biopsies to evaluate 1) bone marrow burst forming unit erythroid (BFU-E) and colony forming unit erythroid (CFU-E) proliferative capacity, and 2) bone marrow mononuclear cell EPO-receptor (EPO-R) number. During Phase B, there was a progressive rise in hematocrit and hemoglobin values, so that within the sixth month, the rHuEPO dose was reduced to 80 +/- 15 U/kg body weight three times per week. At the same time, an increase in serum IL-3, IL-6, and IL-10 levels was seen, whereas serum IL-1 beta, TNF-alpha, and IFN-gamma levels decreased. This was accompanied by a rise in BFU-E and CFU-E growth and in bone marrow mononuclear cell EPO-R number. During Phase B, after the dialysis session, serum EPO levels increased by about 30% in comparison with pre dialysis values, whereas during Phase A they decreased by about 14%. In HD patients, EPO resistance may caused either by absorption of rHuEPO to the cuprophan M, or an increased release of cytokines that inhibit erythropoiesis, such as IL-1 beta, TNF-alpha, and IFN-gamma, and to a decrease in stimulatory cytokines such as IL-3, IL-6, and IL-10. These negative phenomena are reversed by the use of biocompatible dialysis techniques such as PFD. SN - 1058-2916 UR - https://www.unboundmedicine.com/medline/citation/9360100/Recombinant_human_erythropoietin_resistance_in_hemodialysis__Effects_of_paired_filtration_dialysis_ L2 - https://Insights.ovid.com/pubmed?pmid=9360100 DB - PRIME DP - Unbound Medicine ER -