Background and Methods Anemia is common in patients with chronicrenal insufficiency and secondary hyperparathyroidism. Erythropoietintherapy is effective, but the dose required varies greatly.One possible determinant of the efficacy of erythropoietin therapyis the extent of marrow fibrosis caused by hyperparathyroidism.We examined the relation between the erythropoietic responseto erythropoietin and hyperparathyroidism in a cross-sectionalstudy of 18 patients undergoing hemodialysis who had receivederythropoietin therapy for one to three years. In 7 patients(the poor-response group) the dose of intravenous erythropoietinneeded to maintain a mean (±SD) target hematocrit of35 ±3 percent was >100 units per kilogram of bodyweight three times a week, and in 11 patients (the good-responsegroup) it was 100 units per kilogram. In all patients, indexesof the adequacy of dialysis and the extent of hyperparathyroidismand aluminum toxicity were determined monthly, and bone histomorphometrywas performed.
Results The mean (±SD) dose of erythropoietin requiredto maintain the target hematocrit was 174 ±33 units perkilogram three times a week in the poor-response group and 56±18 units per kilogram in the good-response group. Themean ages, duration and adequacy of dialysis, increment in hematocrit,iron requirements, and serum concentrations of calcium, phosphate,and aluminum were similar in the two groups. The percentagesof osteoid volume and surface, the osteoid thickness, and thestainable aluminum content of bone were similar in the two groups.In contrast, the mean serum parathyroid hormone concentration,the percentages of osteoclastic and eroded bone surfaces, andthe degree of marrow fibrosis were greater in the poor-responsegroup than in the good-response group (P = 0.03, P = 0.04, P= 0.009, and P = 0.009, respectively).
Conclusions In patients with uremia, the dose of erythropoietinneeded to achieve an adequate hematocrit response may dependon the severity of secondary hyperparathyroidism and the extentof bone marrow fibrosis.
Source Information
From the Divisions of Bone and Mineral Metabolism (D.S.R., M.S.) and Nephrology (R.M.), Department of Medicine, Henry Ford Hospital, Detroit.
Address reprint requests to Dr. Rao at the Bone and Mineral Division, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202.
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100 units per kilogram. In all patients, indexes of the adequacy of dialysis and the extent of hyperparathyroidism and aluminum toxicity were determined monthly, and bone histomorphometry was performed. 
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