Factors Influencing Anemia In Maintenance Hemodialysis Patients

IntroductionAnemia is a common complication of hemodialysis and is associated with significant morbidity and mortality. The major cause of anemia is an inadequate production of the erythropoietin (EPO). Recombinant human erythropoietin (rHuEPO) is used to correct anemia in the majority of hemodialysis patients, but not all of hemodialysis patients have the complication of anemia. Parfrey P. believed that the morbidity of anemia in end-stage renal disease was 90%. Takeda A et al. reported that 25 patients (25/158 cases) undergoing regular hemodialysis treatment did not need rHuEPO to keep the target hematocrit of 30%. Eschbach JW et al. reported 58 hemodialysis patients (58/988 cases) did not need rHuEPO to keep the hematocrit of (40. 8±4. 3)%. We noticed that some dialysis patients did not need rHuEPO to keep a comparative high hemoglobin levels too. Besides of the inadequate production of EPO, The common causes of anemia are iron deficiency, inflammatory status, aluminum in toxication, uremic toxins, nutrition dif iciency, underdialysis and using angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor blockade (ARB) . Is there any other factor influencing the level of hemoglobin ?Umemoto Y. et al. discovered that leptin synergized with stem cell factor(SCF) proliferated primitive hematopoietic progenitors in vitro. Other researchs discovered that parathyroid hormone can inhibit the progress of hemotopoisis and induce rHuEpo hyporesponsiveness, via the induction of bone marrow f ibrosis. The aim of the present study was to investigate the factors influencing anemia in hemodialysis patients.Materials and methods1. Objects and groupsA cohort of 73 patients taking regular hemodialysis between Jan. 2003 and Dec. 2003 in our center was studied. The patients were divided into EPO-treated group and non-EPO-treated group.2. Observing indexesWe obeserved the clinical characters, the level of hemoglobin, serum albumin, prealbumin, triglyceride, cholesterol, ferritin, transferrin, high sensitive C reactive protein, immunoreactive parathyroid hormone, leptin and erythropoietin.3. Detection of serum LEP and EPO concentrations by Enzyme-linked immunoabsorbent assay.4. The levels of hemoglobin, serum albumin, pre-albumin, triglyceride, cholesterol, ferritin, transferrin, C reactive protein and immunoreactive parathyroid hormone were detected at the laboratory of our hospital.5. Statistical analysisSPSS 11. 5 was used. Bilateral P value <0. 05 was considered statistically significant.Results1. Comparison of the clinical charactersThere were no significant differences between two groups in age, sex, primary diseases , period for hemodialysis, Kt/V, percentage of hypertension, blood pressure and the use of ACEI and ARB (p>0.05) .2. Comparison of the blood indexesThere were no significant differences in these indexes except for theserum leptin concentration between two groups.The non-EPO treated group had a higher level of serum leptin(P=0. 035).3. Correlation analysis between hemoglobin and the indexesThere were no correlations between hemoglobin and the indexs except for serum leptin.There was a positive correlation between hemoglobin and serum leptin in all patients (r=0.258, P=0. 041).Conclusion1. Some hemodialysis patients could keep the level of hemoglobin of 70g/L without treated by rHuEPO.2. The leval of serum leptin of Non-EPO treated group was higher than that of EPO-treated group. Serum leptin concentration maybe have a positive correlation with hemoglobin in hemodialysis patients .