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Timing and determinants of erythropoietin deficiency in chronic kidney disease.
Mercadal L., Metzger M., Casadevall N., Haymann J. P., Karras A., Boffa J.-J., Flamant M., Vrtovsnik F., Stengel B., Froissart M.
Clinical Journal of the American Society of Nephrology 7, 1 (2012) 35-42 - http://www.hal.inserm.fr/inserm-00739807
 (22096037) 
Timing and determinants of erythropoietin deficiency in chronic kidney disease.
Lucile Mercadal () 1, Marie Metzger1, Nicole Casadevall2, 3, Jean Philippe Haymann4, 5, Alexandre Karras6, Jean-Jacques Boffa4, 7, Martin Flamant8, 9, François Vrtovsnik9, 10, Bénédicte Stengel1, Marc Froissart1, 11, Nephrotest Study Group Collaboration(s)
1 :  CESP - Centre de recherche en épidémiologie et santé des populations
INSERM : U1018 – Université Paris XI - Paris Sud – Hôpital Paul Brousse – Assistance publique - Hôpitaux de Paris (AP-HP)
16 avenue Paul Vaillant Couturier 94807 Villejuif Cedex, France
France
2 :  Service d'Hématologie [Saint-Antoine]
Hôpital Saint-Antoine – Assistance publique - Hôpitaux de Paris (AP-HP) – Université Pierre et Marie Curie (UPMC) - Paris VI
184, rue du Faubourg Saint-Antoine 75012 Paris
France
3 :  Hematopoïese normale et pathologique
INSERM : U1009 – Institut Gustave Roussy
Villejuif
France
4 :  Remodelage et Reparation du Tissu Renal
INSERM : U702 – Université Pierre et Marie Curie (UPMC) - Paris VI
Hopital Tenon PARIS VI 4, Rue de La Chine 75970 PARIS CEDEX 20
France
5 :  Service de Physiologie [Tenon]
Assistance publique - Hôpitaux de Paris (AP-HP) – Hôpital Tenon – Université Pierre et Marie Curie (UPMC) - Paris VI
4, rue de la Chine 75020 Paris
France
6 :  Service de Néphrologie [HEGP]
Hôpital européen Georges Pompidou – Assistance publique - Hôpitaux de Paris (AP-HP) – Université Pierre et Marie Curie (UPMC) - Paris VI
20, rue Leblanc 75015 Paris
France
7 :  Service de Néphrologie et Dialyses [Tenon]
Hôpital Tenon – Assistance publique - Hôpitaux de Paris (AP-HP) – Université Pierre et Marie Curie (UPMC) - Paris VI
4, rue de la Chine 75020 Paris
France
8 :  Service de Physiologie [Bichat-Claude Bernard]
Hôpital Bichat - Claude Bernard – Assistance publique - Hôpitaux de Paris (AP-HP) – Université Pierre et Marie Curie (UPMC) - Paris VI
46, rue Henri-Huchard 75018 Paris
France
9 :  Immunopathologie rénale, récepteurs et inflammation
INSERM : U699 – Université Paris VII - Paris Diderot
Faculte de Medecine Xavier Bichat 16, Rue Henri Huchard 75870 PARIS CEDEX 18
France
10 :  Service de Néphrologie [Bichat-Claude Bernard]
Hôpital Bichat - Claude Bernard – Assistance publique - Hôpitaux de Paris (AP-HP) – Université Pierre et Marie Curie (UPMC) - Paris VI
46, rue Henri-Huchard 75018 Paris
France
11 :  Service de physiologie, explorations fonctionnelles et radioisotopes
Assistance publique - Hôpitaux de Paris (AP-HP) – Hôpital européen Georges Pompidou – Université Paris V - Paris Descartes
20, rue Leblanc 75015 Paris
France
Erythropoietin and chronic kidney disease
BACKGROUND AND OBJECTIVES: Anemia in patients with CKD is highly related to impaired erythropoietin (EPO) response, the timing and determinants of which remain unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study measured EPO levels and studied their relation to GFR measured by 51Cr-EDTA renal clearance (mGFR) in 336 all-stage CKD patients not receiving any erythropoiesis-stimulating agent. RESULTS: In patients with anemia defined by World Health Organization criteria (hemoglobin [Hb] <13 g/dl in men and 12 g/dl in women), EPO response to Hb level varied by mGFR level. EPO and Hb levels were negatively correlated (r=-0.22, P=0.04) when mGFR was >30 ml/min per 1.73 m(2), whereas they were not correlated when mGFR was <30 (r=0.09, P=0.3; P for interaction=0.01). In patients with anemia, the ratio of observed EPO to the level predicted by the equation for their Hb level decreased from 0.72 (interquartile range, 0.57-0.95) for mGFR ≥60 ml/min per 1.73 m(2) to 0.36 (interquartile range, 0.16-0.69) for mGFR <15. Obesity, diabetes with nephropathy other than diabetic glomerulopathy, absolute iron deficiency, and high C-reactive protein concentrations were associated with increased EPO levels, independent of Hb and mGFR. CONCLUSIONS: Anemia in CKD is marked by an early relative EPO deficiency, but several factors besides Hb may persistently stimulate EPO synthesis. Although EPO deficiency is likely the main determinant of anemia in patients with advanced CKD, the presence of anemia in those with mGFR >30 ml/min per 1.73 m(2) calls for other explanatory factors.
Sciences du Vivant/Santé publique et épidémiologie
Anglais
1555-9041

Articles dans des revues avec comité de lecture
10.2215/CJN.04690511
Clinical Journal of the American Society of Nephrology (Clin J Am Soc Nephrol)
Publisher American Society of Nephrology
ISSN 1555-9041 (eISSN : 1555-905X)
internationale
01/2012
17/11/2011
7
1
35-42

Adult – Aged – Chronic Disease – Erythropoietin – Female – Glomerular Filtration Rate – Hemoglobins – Humans – Kidney Diseases – Male – Middle Aged – Multivariate Analysis – Time Factors
The NephroTest CKD cohort study is supported by grants from: Inserm GIS-IReSP AO - 8113LS TGIR (BS); French Ministry of Health AOM 09114 (MF); Inserm AO 8022LS (BS); Agence de la Biomédecine R0 8156LL (BS), AURA (MF) and Roche 2009-152-447G (MF). The Nephrotest initiative was also sponsored by unrestricted grants from F.Hoffman-La Roche Ltd. (LM).
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EPO-cjasn-revisedfinal_sans_marques.doc(167.5 KB)
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