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Publication:

Timing and Determinants of Erythropoietin Deficiency in Chronic Kidney Disease

Lucile Mercadal, Marie Metzger, Nicole Casadevall, Jean Philippe Haymann, Alexandre Karras, Jean-Jacques Boffa, Martin Flamant, François Vrtovsnik, Bénédicte Stengel, Marc Froissart,  and on behalf of the NephroTest Study Group

CJASN November 17, 2011 CJN.04690511; published ahead of print November 17, 2011, doi:10.2215/CJN.04690511

The secretion of endogenous erythropoietin is directly linked to hemoglobin decrease but we further suggest that other factors are determinant factors of erythropoietin level. 

These factors are obesity, diabetes with vascular nephropathy,  inflammation and absolute iron deficiency. We also more precisely characterized the erythropoietin deficiency that worsens with renal function decline. And lastly we confirm that for patients with a glomerular filtration  rate (GFR) under 30 ml/min/1.73 m²,  the feedback of  hemoglobin on erythropoietin is lacking.

But the other determinant factors seem to have a role even under this threshold value of GFR. These findings bring a more complex view of the regulation of erythropoeitn secretion.

In certain conditions (diabetes with vascular nephropathy, chronic inflammation, obesity and absolute iron deficiency), endogenous erythropoietin level can already be enhanced, indicating that anemia is associated with a resistance to endogenous EPO.  

Further prescriptions of erythropoiesis stimulating agent (ASE) on these conditions could have lower advantages and higher risks.

It should be interesting to test the hypothesis that the endogenous EPO level could add information on the response to ASE and help to define more precisely the benefit of such prescription.