Am J Kidney Dis. 1997 Jul;30(1):28-35. Unique Identifier : AIDSLINE
To determine the factors that govern their response to erythropoietin
(EPO), we conducted a cross-sectional study of all patients in four
outpatient hemodialysis facilities in Brooklyn, NY, who had end-stage
renal disease (ESRD) and human immunodeficiency virus (HIV) infection
and were receiving recombinant EPO. We also compared the hematocrit and
EPO requirements of these patients to those of a control group of
hemodialysis patients without HIV infection. We documented known
duration of HIV infection, and total CD4 count was measured once. In
both groups, hematocrit was measured weekly for 5 weeks and a mean value
calculated for each subject. Transferrin saturation was measured twice
and a mean value calculated for each subject. Intensity of hemodialysis
was assessed by measuring both percent reduction of urea and serum
albumin concentration twice; mean values were calculated for each
subject. Twenty-nine (88%) of 33 study subjects had acquired
immunodeficiency syndrome. Mean known duration of HIV infection was 49
+/- 32.5 months (median, 48 months), and mean total CD4 count was 143
+/- 152.4 cells/mm3 median, 72 cells/mm3). Mean hematocrit in the study
subjects was 27.4% +/- 4.7% compared with 27.6% +/- 3.7% in the controls
(P = 0.69). Mean thrice-weekly EPO dose was higher in the study subjects
(90 +/- 52 U/kg body weight) than in the controls (62 36 U/Kg body
weight) (P = 0.001). Among the study subjects, hematocrit had direct
univariate correlations with serum albumin concentration (r = 0.43; P =
0.02), transferrin saturation (r = 0.4; P = 0.03), and percent reduction
of urea (r = 0.4; P = 0.02), but not with total CD4 count (r = -0.05; P
= 0.8) or known duration of HIV infection (r = 0.11; P = 0.55). There
was an inverse correlation between hematocrit and dose of EPO (r = -0.5;
P = 0.003). Multiple regression analysis showed that transferrin
saturation (P = 0.01) and percent reduction of urea (P = 0.003) had
direct correlations with hematocrit after adjustment for other factors.
There was an inverse relationship between hematocrit and dose of EPO (P
= 0.0006). We conclude that in patients with ESRD and HIV infection
receiving hemodialysis, the response to EPO (hematocrit) is modulated by
the dose of EPO, quantity of hemodialysis, and transferrin saturation,
but not by the severity of HIV disease. Hemodialysis patients infected
with HIV receive a higher dose of EPO than those without HIV infection.
*Epoetin Alfa/THERAPEUTIC USE *Erythropoietin, Recombinant/THERAPEUTIC
USE *Hematinics/THERAPEUTIC USE *HIV Infections/BLOOD *HIV
Infections/COMPLICATIONS *Kidney Failure, Chronic/BLOOD *Kidney
Failure, Chronic/COMPLICATIONS