Hemodialysis and continuous ambulatory peritoneal dialysis effects on erythropoiesis in renal failure

Hemodialysis and continuous ambulatory peritoneal dialysis effects on erythropoiesis in renal failure. Parameters of erythropoiesis were studied in patients with endstage renal disease established on continuous ambulatory peritoneal dialysis (CAPD) and regular hemodialysis treatment (RDT). Serum erythropoietin was measured by radioimmunoassay, and erythroid progenitor cell (CFU-E) formation was assayed in fetal mouse liver cultures. Serum erythropoietin concentrations in both CAPD (35.3 ± 4.0 mU/ml) and RDT (31.9 ± 1.9 mU/ml) patients were significantly higher (P < 0.01) than normal values (23.1 ± 1.0 mU/ml). The serum erythropoietin concentration did not correlate with either hematocrit or inhibition of CFU-E formation in either group of dialysis patients. In both CAPD and RDT patients the hematocrit correlated significantly (P < 0.001) with the degree of serum inhibition of CFU-E formation. CFU-E formation decreased from 74.5 ± 2.5 to 62.5 ± 3.5% of control with increasing concentrations of uremic serum in cell cultures from 5 to 20%. In RDT patients a single hemodialysis produced a decrease in the mean serum erythropoietin concentration from 31.8 ± 2.1 to 27.4 ± 1.8 mU/ml (P < 0.01) but no significant change in CFU-E formation. In conclusion, although serum immunoreactive erythropoietin levels are elevated above the normal range in dialysis patients, the response remains inadequate for the severity of the anemia, and it is the degree of serum inhibition of erythropoiesis in both CAPD and RDT patients which correlates with and possibly determines the degree of anemia. Effets de l'hémodialyse et de la dialyse péritonéale continue ambulatoire sur l'erythropoïèse au cours de l'insuffisance rénale. Les paramètres de l'érythropoïèse ont été étudiés chez des malades avec une néphropathie terminale en dialyse péritonéale continue ambulatoire (CAPD) et en hémodialyse périodique (RDT). L'érythropoïétine sérique a été mesurée par dosage radioimmunologique, et la formation de cellules souches érythroïdes (CFU-E) a été dosée dans des cultures de foie foetal de souris. Les concentrations d'érythropoïétine sérique chez les malades en CAPD (35,3 ± 4,0 mU/ml) et en RDT (31,9 ± 1,9 mU/ml) étaient significativement plus élevées (P < 0,01) que les valeurs normales (23,1 ± 1,0 mU/ml). La concentration d'érythropoïétine sérique n'était corrélée ni à l'hématocrite, ni à l'inhibition de formation de CFU-E dans aucun groupe d'hémodialysés. Chez les malades en CAPD et en RDT, l'