Correction of the Anemia of End-Stage Renal Disease with Recombinant Human Erythropoietin

TLDR

Recombinant human erythropoietin was given intravenously three times weekly after dialysis to 25 anemic end‑stage renal disease patients, with transfusion needs, hematocrit, ferrokinetics, and reticulocyte responses monitored. Dose‑dependent erythropoiesis was achieved, with 500 units/kg raising hematocrit by up to 10 percentage points in three weeks, reducing transfusion dependence in 12 of 18 patients, elevating hematocrit to ≥35 % in 11, and improving ferrokinetics 3–4×, while no organ toxicity or antibody formation occurred. N Engl J Med 1987; 316: 73–8.

Abstract

We administered recombinant human erythropoietin to 25 anemic patients with end-stage renal disease who were undergoing hemodialysis. The recombinant human erythropoietin was given intravenously three times weekly after dialysis, and transfusion requirements, hematocrit, ferrokinetics, and reticulocyte responses were monitored. Over a range of doses between 15 and 500 units per kilogram of body weight, dose-dependent increases in effective erythropoiesis were noted. At 500 units per kilogram, changes in the hematocrit of as much as 10 percentage points were seen within three weeks, and increases in ferrokinetics of three to four times basal values, as measured by erythron transferrin uptake, were observed. Of 18 patients receiving effective doses of recombinant human erythropoietin, 12 who had required transfusions no longer needed them, and in 11 the hematocrit increased to 35 percent or more. Along with the rise in hematocrit, four patients had an increase in blood pressure, and a majority had increases in serum creatinine and potassium levels. No organ dysfunction or other toxic effects were observed, and no antibodies to the recombinant hormone were formed. These results demonstrate that recombinant human erythropoietin is effective, can eliminate the need for transfusions with their risks of immunologic sensitization, infection, and iron overload, and can restore the hematocrit to normal in many patients with the anemia of end-stage renal disease. (N Engl J Med 1987; 316: 73–8.)