PMID- 18045859
OWN - NLM
STAT- MEDLINE
DCOM- 20080130
LR  - 20211020
IS  - 1555-905X (Electronic)
IS  - 1555-9041 (Print)
IS  - 1555-9041 (Linking)
VI  - 3
IP  - 1
DP  - 2008 Jan
TI  - Serum albumin is strongly associated with erythropoietin sensitivity in 
      hemodialysis patients.
PG  - 98-104
AB  - BACKGROUND AND OBJECTIVES: In hemodialysis patients, the hematological response 
      to erythropoietin (epo) is variable and clinical factors that explain this 
      variability are incompletely understood. We tested the hypothesis that the 
      variability in hemoglobin (Hgb) response (epo sensitivity) is determined by key 
      nutritional, inflammation, and oxidative stress markers. DESIGN, SETTING, 
      PARTICIPANTS, & MEASUREMENTS: Eighty-two consecutive patients on hemodialysis had 
      3 consecutive monthly predialysis evaluations of Hgb, total white blood cell 
      (WBC) count, serum albumin, malondialdehyde (MDA), and monocyte chemoattractant 
      protein-1 (MCP1). We analyzed the time course of Hgb in relationship to serum 
      albumin, WBC, MDA, MCP1, epo and iron administration, and tests of iron 
      sufficiency in a linear growth curve model. RESULTS: Subjects with higher Hgb had 
      a fall in Hgb and vice versa, regressing to a mean Hgb (SD) of 11.8 g/dl (1.8 
      g/dl). Whereas the average slope of Hgb was flat, the SD of slopes was 0.63 g/dl, 
      which explained 39% of the variance in Hgb. Nonuse of epo was associated with a 
      mean Hgb change of -0.18 g/dl (95% confidence interval [CI] -0.26 to -0.10) per 
      10,000 IU epo/mo (P < 0.05). Epo use was associated with steeper rate of change 
      at 0.04 g/dl per mo per 10,000 IU (95% CI 0.01 to 0.07) (P < 0.01). Hgb at 
      baseline was 0.73 g/dl higher for each 1-g/dl increase in albumin, and the rate 
      of change increased by 0.49 g/dl per mo for each 1-g/dl increase in albumin 
      concentration. WBC, MDA, or MCP1 had no role in predicting the baseline Hgb or 
      its change over time. CONCLUSIONS: Serum albumin concentration is an important 
      predictor of both baseline Hgb and epo sensitivity in chronic hemodialysis 
      patients. Factors that improve serum albumin may also improve Hgb in hemodialysis 
      patients.
FAU - Agarwal, Rajiv
AU  - Agarwal R
AD  - Division of Nephrology, Department of Medicine, Indiana University School of 
      Medicine, and the Richard L. RoudebushVA Medical Center, Indianapolis, Indiana 
      46202, USA. ragarwal@iupui.edu
FAU - Davis, Joyce L
AU  - Davis JL
FAU - Smith, Linda
AU  - Smith L
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20071128
PL  - United States
TA  - Clin J Am Soc Nephrol
JT  - Clinical journal of the American Society of Nephrology : CJASN
JID - 101271570
RN  - 0 (Biomarkers)
RN  - 0 (CCL2 protein, human)
RN  - 0 (Chemokine CCL2)
RN  - 0 (Hemoglobins)
RN  - 0 (Serum Albumin)
RN  - 11096-26-7 (Erythropoietin)
RN  - 4Y8F71G49Q (Malondialdehyde)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anemia/blood/*drug therapy
MH  - Biomarkers
MH  - Chemokine CCL2/blood
MH  - Erythropoietin/*therapeutic use
MH  - Female
MH  - Hemoglobins/metabolism
MH  - Humans
MH  - Inflammation/blood
MH  - Kidney Failure, Chronic/blood/*complications
MH  - Leukocyte Count
MH  - Male
MH  - Malondialdehyde/blood
MH  - Middle Aged
MH  - Oxidative Stress
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - *Renal Dialysis
MH  - Serum Albumin/*metabolism
MH  - Treatment Outcome
PMC - PMC2390989
EDAT- 2007/11/30 09:00
MHDA- 2008/01/31 09:00
PMCR- 2009/01/01
CRDT- 2007/11/30 09:00
PHST- 2007/11/30 09:00 [pubmed]
PHST- 2008/01/31 09:00 [medline]
PHST- 2007/11/30 09:00 [entrez]
PHST- 2009/01/01 00:00 [pmc-release]
AID - CJN.03330807 [pii]
AID - 0807 [pii]
AID - 10.2215/CJN.03330807 [doi]
PST - ppublish
SO  - Clin J Am Soc Nephrol. 2008 Jan;3(1):98-104. doi: 10.2215/CJN.03330807. Epub 2007 
      Nov 28.