Background
Prevalence of anaemia in patients with autosomal dominant polycystic kidney disease (ADPKD) increases according to the severity of chronic kidney disease (CKD).
However,little is known about the relationship between kidney structure modification and recombinant human erythropoietin (rHu-EPO) requirement in these patients.
Aim of this study was to evaluate the role of renal cysts and kidney size on rHu-EPO requirement in severe CKD and naive chronic hemodialysis (HD) patients.
Methods
A total of 43 pts with ADPKD and anemia treated with alfa-erythropietin (rHu-EPO) were enrolled(16 pts with CKD Stage 4 and 28 naive chronic HD pts), the total volume of the four largest cysts(cysts-Vol)and the mean antero-posterior renal diameter (AP) were prospectively followed-up for 18months with kidney ultrasound.
Results
Mean age was 65±13yrs. At baseline, AP was 19.4±2.1 cm, cysts-Vol 4073±69 cm3.
During the 18 months follow-up,haemoglobin(Hb) was 10.80±7 g/dl, rhEPO dose was 14403±7518 UI/week, and rHu-EPO/Hb ratio was 1379±780.
In fully adjusted model [table in figure 1] cysts Vol and AP predict EPO dose and EPO/Hb ratio and explain a large
amount of variability [figures 2, 3, 4, 5].
Conclusions
Cysts volume is useful to predict prospectively the rHu-EPO requirement.
This assumption is valid even in chronic dialysis patients, where the renal function is completely lost.