18 Erythropoietin Requirements in Chronic Hemodialysis Patients After Failure of Kidney Transplant
Authors: Škofic N , Ponikvar R , Bren A F , Kandus A , Varl J , Malovrh M , Buturović‐Ponikvar J 
Published: February 2005

Introduction  Studies have shown that presence of a failed kidney transplant in patients returning to chronic hemodialysis following failure of their kidney transplant is associated with chronic inflammatory state and erythropoietin resistance. The aim of our retrospective clinical study was to analyze erythropoietin requirements in chronic hemodialysis patients after failure of kidney transplant.

Patients and methods  Fifteen chronic hemodialysis patients after failure of kidney transplant, 11 males and 4 females, at the mean age of 47.3 ± 13.3 years (range 21–65 years), were included in the study. Twelve patients had a failed kidney transplant still in place (group A) and 3 patients were had had a failed transplant nephrectomy (group B). Hemoglobin level (Hb), erythropoietin dose per week (EPO/week), erythropoietin dose per week per dry body weight (EPO/week per bw), erythropoietin resistance index (ERI = EPO/week per bw per Hb), C‐reactive protein (CRP), albumin level, ferritin level, transferrin saturation (TS) and creatinine level were analyzed monthly from January to September 2004.

Results   (see Table A18)

 Group A

Jan.
Feb.
Mar.
Apr.
May
Jun.
Jul.
Aug.
Sep.

Hb
(g/L)
 116.8 ± 10.5
 112.0 ± 12.0
 114.1 ± 10.3
 114.8 ± 7.8
 114.9 ± 13.6
 111.4 ± 13.4
 110.3 ± 10.8
111.7 ± 10.9
 112.9 ± 16.0

EPO/week
 
(IU/week )
10 444 ± 6 654
10 000 ± 7 123
10 333 ± 6 652
10 444 ± 6 267
10 909 ± 5 804
10 375 ± 6 146
10 583 ± 5 534
9 727 ± 5 101
10 273 ± 5 179

EPO/week/bw
 
(IU/week/kg)
 169.0 ± 100.3
 160.1 ± 108.2
 166.6 ± 101.1
 168.1 ± 93.5
 177.6 ± 88.1
 170.0 ± 95.2
 171.6 ± 87.2
159.3 ± 79.9
 171.4 ± 85.8

ERI
 
(IU/week/kg/g/dL)
  15.1 ± 11.3
  14.9 ± 8.9
  14.7 ± 8.3
  16.1 ± 9.0
  17.4 ± 8.7
  16.0 ± 8.6
  14.7 ± 8.2
 16.2 ± 9.6
  15.1 ± 9.9

CRP
(mg/L)
   8.3 ± 3.5
   8.3 ± 9.8
   8.6 ± 5.8
   7.1 ± 6.1
   8.3 ± 5.9
  10.6 ± 10.9
  14.5 ± 15.5
 15.5 ± 21.1
  19.3 ± 8.6

Albumin
(g/L)
  38.0 ± 7.0
  38.2 ± 8.3
  38.7 ± 2.1
  38.3 ± 6.8
  38.1 ± 7.6
  37.7 ± 7.4
  37.3 ± 8.2
 36.1 ± 9.6
  37.0 ± 8.6

Ferritin
(mg/L)
   701 ± 777
   365 ± 324
–
–
–
   584 ± 412
–
–
   736 ± 590

TS
(%)
  31.3 ± 11.4
  29.9 ± 12.4
  31.8 ± 8.4
  31.1 ± 9.8
  29.0 ± 7.6
  28.2 ± 12.2
  31.5 ± 11.9
 27.2 ± 13.0
  27.4 ± 11.0

Creatinine
(mmol/L)
 1.046 ± 275
   879 ± 283
   985 ± 322
   892 ± 206
   929 ± 319
   859 ± 309
   997 ± 328
  870 ± 300
   860 ± 283

  Group B  

Jan.
Feb.
Mar.
Apr.
May
Jun.
Jul.
Aug.
Sep.

Hb
(g/L)
110.7 ± 4.5
111.3 ± 2.9
111.3 ± 3.2
 113.7 ± 7.2
 116.7 ± 2.9
 125.7 ± 7.2
 120.3 ± 0.6
122.0 ± 14.1
 120.7 ± 9.1

EPO/week
 
(IU/week )
8 333 ± 3 512
8 333 ± 3 512
9 667 ± 4 041
11 667 ± 6 506
12 667 ± 6 807
10 667 ± 5 132
10 667 ± 5 132
8 667 ± 5 508
10 400 ± 5 048

EPO/week/bw
 
(IU/week/kg)
117.1 ± 51.5
117.1 ± 51.5
134.4 ± 53.5
 163.1 ± 94.4
 177.3 ± 97.3
 148.8 ± 66.6
 148.8 ± 66.6
124.8 ± 85.9
 151.0 ± 76.6

ERI
 
(IU/week/kg/g/dL)
 10.5 ± 4.4
 12.2 ± 5.1
 14.7 ± 9.0
  15.3 ± 8.6
  11.8 ± 5.3
  12.4 ± 5.5
  10.8 ± 8.7
 12.8 ± 6.9
  10.5 ± 4.2

CRP
(mg/L)
  8.0 ± 7.1
–
 11.5 ± 12.0
   7.0 ± 6.1
–
   5.0 ± 3.5
–
–
   5.7 ± 3.1

Albumin
(g/L)
 42.7 ± 4.5
–
–
  43.7 ± 3.2
–
  42.0 ± 1.0
–
–
  42.0 ± 2.0

Ferritin
(mg/L)
  461 ± 121
–
–
   549 ± 146
–
   597 ± 237
–
–
   708 ± 248

TS
(%)
 29.0 ± 15.5
–
–
  23.3 ± 10.1
–
  27.0 ± 9.5
–
–
  26.0 ± 5.6

Creatinine
(mmol/L)
–
1.067 ± 103
–
–
 1.091 ± 62
–
 1.100 ± 46
–
 1.038 ± 30

Conclusion Our study showed that chronic hemodialysis patients with a failed kidney transplant still in place had increased erythropoietin requirements. They exhibited higher erythropoietin resistance with worse anemia and worse biochemical parameters characteristic of chronic inflammatory state compared to chronic hemodialysis patients after a failed transplant nephrectomy.