Uremia and the Liver. I. The Liver and Erythropoiesis in Chronic Renal Failure

Meyrier, Alain; Simon, Pierre; Boffa, G. A.; Brissot, Pierre

doi:10.1159/000182229

Cited by 27 publications

(7 citation statements)

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“…This finding seems to be related to the capacity of androgens to increase serum erythropoietin levels by a direct effect on the bone marrow [27,28]. It has also been suggested that androgens increase extrarenal EPO production via their potential hepatotoxic effects, whereby injured hepatocytes would be capable of producing EPO, as occurs in cases of HCV liver disease [29]. Another pathway by which androgens could stimulate erythropoiesis is by increasing IGF-1.…”

Section: Discussionmentioning

confidence: 99%

Factors Related to the Absence of Anemia in Hemodialysis Patients

et al. 2011

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Background: A small number of hemodialysis (HD) patients have normal hemoglobin (Hb) levels without the need for erythropoiesis-stimulating agents (ESAs). The factors associated with this condition have been little studied. The objective of this prospective study was to determine these factors in a prevalent population of HD patients. Materials and Methods: All patients who had normal Hb levels and who had not received ESAs in the last 6 months (non-ESA group) were included. Epidemiological and laboratory data were collected and we performed an abdominal ultrasound to assess hepatic and renal cysts. This group was compared to a control group of 205 prevalent HD patients on ESA therapy (control group). Results: We included 45 patients (16% from the whole group) in the non-ESA group. In this group, there was a higher proportion of men (76.5 vs. 61%), patients were younger (61.1 ± 14.7 vs. 67.5 ± 15.2 years), had a longer duration of renal replacement therapy (RRT) (9.4 ± 8.3 vs. 5.3 ± 5.8 years) and had a higher prevalence of adult polycystic kidney disease (APKD) and hepatitis C virus (HCV) liver disease (42.2 vs. 10.2%), p < 0.01. In the non-ESA group, HCV+ patients had a lower prevalence of APKD (2.2 vs. 38.4%) and hepatic cysts (2.2 vs. 19.2%), but significantly higher endogenous erythropoietin levels (55.8 ± 37.1 vs. 30.9 ± 38.4 mU/ml). No significant differences in anemia, iron metabolism, insulin, IGF-1 and renin were found between non-ESA and control groups. Non-ESA patients had a significantly higher number of renal (90.6 vs. 36.5%) and hepatic cysts (12.5 vs. 3.4%), and these were also larger in size (3.3 ± 2.4 vs. 1.5 ± 0.8 cm). In the multivariate Cox analysis, independent predictor factors for absence of anemia in HD patients were number of renal cysts >10 cysts (95% CI 1.058–1.405; p = 0.00), HCV+ liver disease (95% CI 1.147–1.511; p = 0.05) and time on RRT (95% CI 1.002–1.121; p = 0.05). Conclusions: The absence of anemia in HD patients is not infrequent. Its frequency is higher in men and younger patients with long-term RRT, in patients with HCV+ liver disease and in APKD. It is associated with increased endogenous erythropoietin production and the presence of renal and hepatic cysts.

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Section: Discussionmentioning

confidence: 99%

Factors Related to the Absence of Anemia in Hemodialysis Patients

et al. 2011

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“…Although there have been many previous reports of cases with improvement of red blood cell status after hepatitis infection in patients on maintenance HD, [20,21] the mechanisms underlying this improvement are incompletely understood. In our review, for many case reports and small series of non-randomized studies, it was suggested that the liver has some potential to produce EPO apart from the kidneys.…”

Section: Discussionmentioning

confidence: 99%

Effect of Hepatitis C Virus on Hemoglobin and Hematocrit Levels in Saudi Hemodialysis Patients

2009

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Background. Hepatitis C virus infection is common among patients undergoing hemodialysis, and HD patients are at high risk for infection with such virus. Recently, some studies and case reports indicated attenuated anemia in HD patients with HCV infection, and they previously considered this to be related to increased erythropoietin production after hepatic stimulation by chronic infection with hepatitis virus. Aim. The aim of our study is to investigate whether HCV-positive HD patients have higher hemoglobin (Hb) and hematocrit (HCT) values compared to HCV-negative patients. Methods. We retrospectively studied 83 chronic HD patients from Prince Salman Center for Kidney Disease, and monthly samples were collected between July 2007 and July 2008. The HCV status was determined by anti-HCV antibodies and confirmed with RNA polymerase chain reaction (PCR). Those with a history of blood transfusion or massive blood loss during the last six months were excluded from the study. Results. Thirty-three percent of our patients tested positive for anti-HCV antibody (51.8% were male). The mean age for HCV-positive group was 54.92 ± 15.61 years, while it was 51.01 ± 14.81 years for the HCV-negative group (p = 0.27). Mean Hb in the HCV-positive group was 11.18 ± 1.41gm/dL compared to 10.87 ± 1.29 gm/dL for the HCVnegative group (p = 0.05). Mean HTC values for the HCVpositive group was 34.4 ± 3.9, compared to 32.41 ± 3.41 for the HCV-negative group 12 months after starting hemodialysis. Eighty-one patients (27 HCV-positive and 54 HCVnegative) received erythropoietin (EPO) therapy. Seventytwo patients (25 HCV-positive and 47 HCV-negative) received IV iron (p = 0.28). Mean erythropoietin dose was (114.83 ± 84.92 IU/kg/week) for HCV-positive compared to (122.2 ± 91.46 IU/kg/week) for HCV-negative group (p = 0.74). Liver function tests were normal except for higher bilirubin level in the HCV-positive group, 7.74 ± 4.03 Umol/L compared to 5.47 ± 3.71 Umol/L in the HCV-negative group (p = 0.01). Conclusion. Our study showed that ESRD patients on HD with HCV infection have higher Hb and HCT levels compared with HCV-negative patients.

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“…Some case reports have addressed attenuated anaemia in HD patients with CH, and they previously considered this was related to increased erythropoietin (EPO) production after hepatic stimulation by chronic infection of hepatitis virus 10–12 …”

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confidence: 99%

“…[5][6][7][8][9] Some case reports have addressed attenuated anaemia in HD patients with CH, and they previously considered this was related to increased erythropoietin (EPO) production after hepatic stimulation by chronic infection of hepatitis virus. [10][11][12] Up to date, it remains awaited to be worked out whether anaemia of CH in HD population would apparently differ from that in hepatitis-free controls. 10,13 To our knowledge, this is the first study in Taiwan to describe in detail the clinical features of viral hepatitis and red cell status (RCS) presented in HD population.…”

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confidence: 99%