Skip to Main content Skip to Navigation
Journal articles

Timing and determinants of erythropoietin deficiency in chronic kidney disease.: Erythropoietin and chronic kidney disease

Abstract : 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.
Document type :
Journal articles
Complete list of metadata

Cited literature [2 references]  Display  Hide  Download
Contributor : Blandine De Lauzon-Guillain Connect in order to contact the contributor
Submitted on : Tuesday, October 9, 2012 - 8:51:08 AM
Last modification on : Sunday, June 26, 2022 - 4:28:38 AM
Long-term archiving on: : Friday, December 16, 2016 - 9:53:15 PM


Files produced by the author(s)



Lucile Mercadal, Marie Metzger, Nicole Casadevall, Jean-Philippe Haymann, Alexandre Karras, et al.. Timing and determinants of erythropoietin deficiency in chronic kidney disease.: Erythropoietin and chronic kidney disease. Clinical Journal of the American Society of Nephrology, American Society of Nephrology, 2012, 7 (1), pp.35-42. ⟨10.2215/CJN.04690511⟩. ⟨inserm-00739807⟩



Record views


Files downloads