Effect of periodic transfusion on erythropoietin concentration in end stage renal disease

It has been reported that a feedback circuit exists between erythropoietin (EPO) concentration and the degree of anemia even in end stage renal disease (ESRD), and growing experience with subcutaneous EPO administration confirms that only slight increases in EPO levels are required to correct renal anemia. Keeping in mind these findings, if a small portion of reserved EPO production could be reactivated in ESRD, it might be biologically significant and vice-versa. From this viewpoint, it is conceivable that periodic long term transfusion might suppress EPO production in ESRD.

In order to see whether periodic transfusion influences the EPO concentration in ESRD, a cross-sectional retrospective study was undertaken by reviewing medical records of 28 non-transfusion patients and 22 transfusion patients with ESRD undergoing hemodialysis.

The EPO concentration of the ESRD group (29.1 +/- 8.0 mU/ml) but only about one twentieth of the control group (578.8 +/- 69.1 mU/ml). In ESRD group, It was 27.9 +/- 8.0 mU/ml in transfusion group and 30.6 +/- 7.9 mU/ml in non-transfusion group. EPO concentration at varying hematocrit (Hct) levels did not differ between the non-transfusion group and transfusion group. There was an inverse relationship seen in the non-transfusion group (p < 0.05) but no relationship was seen between the EPO concentrations and varying Hct levels in the transfusion group. The EPO concentration at equal levels of Hct did not differ between the non-transfusion group and transfusion group. The relationship between EPO concentration and the changes in Hct during the observation period did not differ between the non-transfusion group and transfusion group. Both the total amount of transfusion and the frequency of transfusions did not influence EPO concentration.

periodic long term transfusion does not seem to decrease the sensitivity of the EPO producing cell to the degree of anemia in ESRD.