2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Roman, R. M.B. Articles by Bolton, W. K. Search for Related Content PubMed PubMed Citation Articles by Roman, R. M.B. Articles by Bolton, W. K.

Prospective Study of the Immune Effects of Normalizing the Hemoglobin Concentration in Hemodialysis Patients Who Receive Recombinant Human Erythropoietin

Renato M.B. Roman^*, Peter I. Lobo^*, Ronald P. Taylor^*, David A. Goodkin, John LaBrecque, Kathy L. Powers^* and W. Kline Bolton^*

*University of Virginia Health Sciences Center, Charlottesville, Virginia; and Amgen, Inc., Thousand Oaks, California

Correspondence to Dr. W. Kline Bolton, Division of Nephrology, University of Virginia, Post Office Box 800-133, Charlottesville, VA 22908-0133. Phone: 434-924-5125; Fax: 434-924-5848; E-mail: wkb5s{at}virginia.edu

ABSTRACT. Partial correction of anemia by erythropoietin improves hemodialysis (HD)-associated immunosuppression. It is not known whether hemoglobin normalization improves immune status further. The authors prospectively compared the immune function of HD patients with congestive heart failure or ischemic heart disease on erythropoietin therapy randomized to normal versus anemic blood hemoglobin concentration. HD patients were randomized into a normal hemoglobin group (n = 17, target hemoglobin of 14 ± 1 g/dl) or an anemic hemoglobin group (n = 18, target hemoglobin 10 ± 1 g/dl). Delayed-type hypersensitivity, CD4 and CD8 counts, anti–tetanus toxoid antibody levels, erythrocyte complement receptor 1 expression, and lymphocyte proliferative responsiveness were measured. The observation period was 1 yr, and the trial was open label. Target hemoglobin was achieved and maintained in both groups. Significantly improved cutaneous reactivity was seen in the normal hemoglobin group (P = 0.003). The prevalence of anergy decreased in the normal hemoglobin group (from 60 to 20%) but increased in the anemic hemoglobin group (from 57 to 86%). The anemic hemoglobin group had higher CD8 counts compared with baseline (P = 0.0001) and compared with the normal hemoglobin group (P = 0.038). Both groups had significant increases in tetanus toxoid antibody levels after vaccination but without significant differences between groups. The anemic hemoglobin group had a progressive increase in erythrocyte complement receptor 1 levels compared with baseline (P = 0.002) and relative to the normal hemoglobin group (P = 0.023). There was no consistent pattern of altered proliferative responsiveness of lymphocytes. The data suggest that certain aspects of immune function, particularly delayed-type hypersensitivity, may be improved in HD patients by normalization of hemoglobin through the administration of increased doses of erythropoietin.

This article has been cited by other articles:

				P. Trzonkowski, A. Debska-Slizien, A. Mysliwski, and B. Rutkowski Treatment with recombinant human erythropoietin is associated with rejuvenation of CD8+ T cell compartment in chronic renal failure patients Nephrol. Dial. Transplant., November 1, 2007; 22(11): 3221 - 3227. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673