Serum erythropoietin level in anemia of chronic kidney disease - experience of a Romanian medical centre / Nivelul eritropoietinei serice în anemia din boala renală cronică - experiența unui centru medical românesc
In this study, different aspects of anemia in chronic kidney disease have been observed, starting from the fact that the severity of anemia is associated with the degree of kidney dysfunction, the main cause being the erythropoietin deficiency, which is synthesized mostly by the kidneys. 58 persons were included in this study, 19 patients with non-dialysis-dependent chronic kidney disease, 18 patients with chronic kidney disease who received kidney transplantation and 21 apparently healthy persons. We evaluated the serum level of erythropoietin, serum creatinine, proteinuria, the glomerular filtration rate, the erythrocyte parameters and the correlations between them. The prevalence of anemia in patients with chronic kidney disease was of 51.35%. The hemoglobin concentration in patients with kidney transplantation (12.4 ± 2.7 g/dL) and in non-dialysis-dependent patients (11.7 ± 1.4 g/dL) is significantly different compared to the apparently healthy persons (14.6 ± 0.8 g/dL) (p<0.05). In the case of the non-dialysis-dependent patients who were not treated with erythropoiesis- stimulating agents we found positive associations between the glomerular filtration rate and the number of erythocytes (r = 0.71), hemoglobin (r = 0.65) and hematocrit (r = 0.73), as well as negative associations between creatinine and the number of erythrocytes (r = -0.72), hemoglobin (r = -0.86) and hematocrit (r = -0.88). In patients with kidney transplantation and anemia we observed positive correlations between erythropoietin and the number of erythrocytes (r = 0.69), between the glomerular filtration rate and the number of erythrocytes (r = 0.78) and erythropoietin (r = 0.97), as well as negative correlations between proteinuria and the number of erythrocytes (r= -0.89), hemoglobin (r= -0.72), hematocrit (r = -0.72), and erythropoietin (r = -0.67), and between creatinine and the number of erythrocytes (r = -0.75) and erythropoietin (r = -0.86).
1. National Clinical Guideline Centre (UK). Anaemia Management in Chronic Kidney Disease: Rapid Update 2011. Royal College of Physicians (UK), London 2011;114:1-2.
2. National Kidney Foundation. KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification and stratification. Am J Kidney Dis. 2002;39 (2, suppl 1): S1-S266.
3. Chung M, Moorthy D, Hadar N, Salvi P, Iovin RC, Lau J. Biomarkers for Assessing and Managing Iron Deficiency Anemia in Late-Stage Chronic Kidney Disease. 2012;. Report No.: 12(13)-EHC140-EF.
4. Kaushansky K, Lichtman MA, Beutler E, Kipps TJ, Seligsohn U, Josef T Prchal JT. Williams Hematology, Eighth Edition, Ed. by McGraw-Hill Companies, China 2010; 36.
5. Eschbach JW. The anemia of chronic renal failure. Kidney Int. 1989; 35(1):134-48. DOI: 10.1038/ki.1989.18
6. Stan A. Hematologie laborator citologie. Editura Medicală, Bucureşti 2004; 20:399-400.
7. Malyszko J, Bachorzewska-Gajewska H, Levin-Iaina N, Iaina A, Dobrzycki S. Prevalence of chronic kidney disease and anemia in patients with coronary artery disease with normal serum creatinine undergoing percutaneous coronary interventions: relation to New York Heart Association class. Isr Med Assoc J. 2010; 12(8):489-93.
8. Lewis EF, Pfeffer MA, Feng A. Darbepoetin alfa impact on health status in diabetes patients with kidney disease: a randomized trial. Clin J Am Nephrol. 2011; 6(4):845-55. DOI: 10.2215/CJN.06450710
9. Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. American Journal of Kidney Disease. 2010; 55(4):622-627. DOI: 10.1053/j.ajkd.2010.02.337
10. Ursea C. Metode morfologice şi citochimice în hematologie. În: Radu Păun. Tratat de medicină internă - Hematologie, partea a II-a. Editura Medicală, Bucureşti 1999; 68:991-993.
11. National Kidney Foundation. KDOQI: Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease. Am J Kidney Dis. 2006; 47(Suppl 3):S11.
12. Coliţă D. Anemiile. Generalităţi, clasificare. În: Radu Păun. Tratat de medicină internă - Hematologie, partea a II-a. Editura Medicală, Bucureşti 1999; XX:560.
13. Vanrenterghem Y. Anemia after renal transplantation. Nephrol Dial Transplant. 2004; (Suppl 5):54-58. DOI: 10.1093/ndt/gfh1057
14. Vanrenterghem Y, Ponticelli C, Morales JM, Abramowicz D, Baboolal K, Eklund B, et al. Prevalence and Management of Anemia in Renal Transplant Recipients: A European Survey. Am J Transplant. 2003; 3(7):835-45. DOI: 10.1034/j.1600-6143.2003.00133.x
15. Dobreanu M, Földes A, Gîju S. Patochimia funcţiilor renale. În: Minodora Dobreanu. Biochimie clinică. Implicaţii practice. Ediţia a II-a. Editura Medicală, Bucureşti. 2010;20:467-9.
16. Hallan SI, Stevens P. Screening for chronic kidney disease: which strategy? Journal of the American Society of Nephrology. 2010;23:147-55.
17. Centers for Disease Control and Prevention. Prevalence of chronic kidney disease and associated risk factors - United States, 1999-2004. MMWR Morb Mortal Wkly Rep. 2007;56(8):161-5.
18. Shaheen F, Souqiyyeh MZ, Al-Attar BA. Prevalence of anemia in predialysis chronic kidney disease patients. Saudi J Kidney Dis Transpl. 2011; 22(3):456-63.
19. National Kidney Foundation. KDOQI: Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease: 2007 Update of hemoglobin target. Am J Kidney Dis. 2007; 50(Suppl 3):471. DOI: 10.1053/j.ajkd.2007.06.008
20. Unal A, Sipahioglu MH, Akcakcaya M, Tokgoz B, Sav T, Oymak O, et al. An underappreciated problem in renal transplant recipients: anemia. Transplant Proc. 2008; 40(5):1399-403. DOI: 10.1016/j.transproceed. 2008.03.080
21. Nayak SG, Kiran MK, Fernandes K. Anemia in renal transplant recipients - a persisting problem. Indian J Nephrol. 2005; 15:239-242.
22. Trevitt R, Bennett L on behalf of the EDTNA/ERCA Anemia and Transplant Interest Groups. Anaemia in Renal Transplant Patients: Report of the European survey 2007;1-2.
23. Abassade P, Rabenirina F, Garcon P, Antakly Y, Cador R. Anemia in congestive heart failure. Ann Cardiol Angeiol. 2009; 58(5):289-92. DOI: 10.1016/j.ancard. 2009.09.001
24. Jelkmann W. Regulation of erythropoietin production. J Physiol. 2011;589(Pt 6):1251-8. DOI: 10.1113/jphysiol. 2010.195057
25. Parfrey PS. Critical appraisal of randomized controlled trials of anemia correction in patients with renal failure. Curr Opin Nephrol Hipertens. 2011; 20(2):177-81.DOI: 10.1097/MNH.0b013e3283428bc2
26. Choukroun G, Renou M, Lecaque C, Jaureguy M. TREAT or not to treat: anemia in type 2 diabetes and chronic kidney disease at stages 3 and 4. Nephrol Ther. 2011; 7(1):2-9. DOI: 10.1016/j.nephro.2010.11.003
27. Teehan G, Benz RL. An update on the controversies in anemia management in chronic kidney disease: lessons learned and lost. Anemia. 2011; 2011:623673.
28. Habas E, Khammaj A, Rayani A. Hematologic side effects of azathioprine and mycophenolate in kidney transplantation. Transplant Proc. 2011; 43(2):504-6. DOI: 10.1016/j.transproceed.2011.01.077