Erythrocyte Metabolism during Renal Anemia Treatment with Recombinant Human Erythropoietin

Recombinant human erythropoietin (epoetin) is widely used for the treatment of renal anemia. The aim of our study was to determine the influence of epoetin on erythrocyte metabolism. Thirty-six hemodialysis patients (22 men, 14 female), aged from 17 to 64 years (mean age 43) and 30 healthy volunteers (12 men, 18 female), aged from 25 to 65 years (mean age 40) were studied. Epoetin (Eprex, Janssen-Cilag) was administered subcutaneously with the starting dose of 2000 IU three times per week for twelve months (range from 75 to 133 IU/kg/week, mean dose 102±21 IU/kg/week). Laboratory markers of: hematological response, iron status and erythrocyte metabolism were measured before epoetin administration. Afterwards the markers were controlled every three months. During epoetin treatment a significant increase in hemoglobin concentration was observed (100% patients responded in a positive way to epoetin). The following changes in erythrocyte metabolism were noticed: 1) in glycolytic enzymes: a significant increase in the activity of hexokinase and that of lactate dehydrogenase, 2) in glycolytic intermediates: a significant increase in the 2,3-diphosphoglycerate and adenosine triphosphate concentrations, 3) a significant increase sodium, potassium adenosine triphosphatase concentration, 4) the glucose uptake by erythrocytes significantly decreased while the lactate production remained stable.

During anemia treatment with epoetin in hemodialysis patients not only quantitative but also qualitative changes in erythrocytes were observed.

Adipokines and nutritional status for patients on maintenance hemodialysis

OBJECTIVES

The aim of this study was to investigate the serum concentration of adipokines, such as leptin, adiponectin, and resistin, and assess its relation to nutritional and inflammatory parameters in both overweight and normal weight patients on maintenance hemodialysis.

METHODS

A total of 36 hemodialysis patients (27 M, 9 F; mean age 55.3 +/- 12 yr.) were examined and 23 additional healthy volunteers were recruited as the control group. The concentrations of leptin, leptin receptor, adiponectin, resistin, IL-6, TNFa and CRP were measured by ELISA. Assessment of nutritional status was determined by the levels of albumin, BMI, percentage of body fat (%F), lean body mass (LBM), and Subjective Global Assessment Score (SGA).

RESULTS

According to the SGA 7-points score and the albumin level, 20 patients were of good nutritional status (6-7 points), while 16 patients were mildly malnourished (4-5 points). The concentrations of CRP, resistin, adiponectin, and TNFa were statistically higher in hemodialysis patients than in the control group (p pound 0.05). The adiponectin level was inversely correlated with %F (R Spearman=-0.3; p pound 0.05). The level of leptin was positively correlated with %F as well as with BMI and SGA scores (R Spearman=0.4; p pound 0.05). Although there was no significant difference in the nutritional status between the nonoverweight (BMI 18.5-24.99) and overweight (BMI (3)25.0) groups of patients, in the nonoverweight group there were 12 patients (54.5%) with signs of mild malnutrition compared to 4 malnourished patients (28.5%) in the overweight group. Nonoverweight patients presented significantly lower leptin concentration (12.7 vs 27.8 ug/l) and higher adiponectin level (38.9 vs 32.5 ng/ml) when compared to overweight patients. The levels of IL-6 and TNFa were higher in the nonoverweight group of patients. Overweight patients also had shorter durations of stay in the hemodialysis program (30.5 vs. 87.6 months).

CONCLUSION

The results of our study indicate that lean hemodialysis patients are more prone to malnutrition and inflammation. The increased levels of leptin and decreased levels of adiponectin in the overweight hemodialysis patients support the idea of a reverse epidemiology phenomenon in this group of patients.

Renal transplantation in dialysis patients with the history of coronary artery bypass grafting and cardiac valve replacement

Death with a functioning kidney is the most frequent cause of graft failure. Cardiovascular disease is the most frequent cause of death after renal transplantation. Therefore, prior to grafting, it is mandatory to diagnose and treat coronary artery disease and heart valve impairment. Transplantation is the best option for renal replacement therapy as far as the quality of life and life expectancy are concerned, although patients with such comorbidities may experience a higher short-term mortality risk. The objective for this study was to analyze both short- and long-term results of patients after coronary artery bypass grafting (CABG) or cardiac valve replacement (CVR). The cardiac surgery recipient group (CSR) included 16 patients (15 men, 1 woman) aged from 44 to 73 (mean 54.9 +/- 7.8) years. CABG was performed in 13/16 patients, and CVR in 3/16. The rest of our patients were treated as a comparative noncardiac surgery recipient (non-CSR) group. It consisted of 422 patients (264 men, 158 women) aged from 14 to 68 years (mean 43.2 +/- 12.9). The comparison revealed that graft function estimated at 1 year after transplantation was not different: serum creatinine concentrations of 1.7 +/- 0.2 and 1.6 +/- 0.5 mg/dL in CSR and non-CSR, respectively. One-year patient survival in the CVR group of 93.8% was slightly worse than that in the non-CSR group (97.9%), but death-censored 1-year graft survivals were comparable in both groups (93.8% vs 92%). Urinary tract and cytomegalovirus infections were the most common complications in the CSR group. One patient lost his graft in month 3(rd) due to many serious infectious complications. One patient died at the end of 12 months as a result of a cardiovascular event (1/16). Our single-center results confirm that transplantation in patients after CABG or CVR is a safe procedure; therefore, such patients should be referred into the waiting list.

One-Year Observation of Kidney Allograft Recipients Converted From Cyclosporine Microemulsion to Tacrolimus

The results from previous trials suggested that tacrolimus-based treatment in kidney transplantation was associated with a significantly lower incidence of acute rejection, and that cyclosporine microemulsion (CsA-Me)-treated patients converted to tacrolimus had numerically better 6-year graft survival than those remaining on CsA-Me. Death with a functioning graft and chronic graft nephropathy are the leading causes of late allograft loss. While standard cardiovascular risk factors are relevant, renal function itself becomes an important risk factor for cardiovascular morbidity and mortality in kidney transplantation patients. Expected benefits of the conversion from CsA-Me to tacrolimus with respect to renal function and cardiovascular status were the rationale for this observational study. Twenty one patients underwent conversion due to nephrotoxicity of cyclosporine (n = 18) or side effects (n = 3). Two out of 21 patients did not complete the study. The patient survival after 1 year was 100% in this group of patients; graft survival 94.7%. No cases of de novo diabetes mellitus were identified. Mean serum creatinine fell from 2.13 +/- 0.4 to 1.84 +/- 0.3 mg/dL (P < .02) and calculated glomerular filtration rate increased from 49.6 +/- 14.4 to 56.2 +/- 15.5 mL/min (P < .01). Total cholesterol decreased from 229.4 +/- 50.1 to 195.9 +/- 28.5 mg/dL (P < .005) and, low-density lipoprotein cholesterol from 125.7 +/- 37.3 to 104.4 +/- 22.6 mg/dL (P < .02). No significant changes in mean systolic or diastolic pressure or blood glucose levels were observed. The results of this observational study showed that in a group of patients with raised creatinine levels at entry, conversion to tacrolimus resulted in improved graft function and a more favorable cardiovascular risk profile.

A Single Center Experience in Preemptive Kidney Transplantation

Transplantation is recognized as preemptive if it takes place before the initiation of chronic dialysis. This maneuver has the potential to avoid the morbidity and burden of chronic dialysis. From November 2003 to April 2005, 15 (7 male, 8 female) end-stage renal failure patients of mean age 40 +/- 14.8 years received preemptive grafts from 2 living-related and 13 cadaveric donors, constituting 11.5% of all kidney transplantations performed in our center at that time. The period on the waiting list for preemptive recipients, namely, 2 weeks to 6 months (mean, 2.4 months), was significantly shorter than that of other patients (mean, 13.8 months). The mean creatinine clearance calculated from the Cockroft Gault formula and the mean plasma creatinine level in preemptive recipients before transplantation were 12.7 +/- 3.1 mL/min and 6.6 +/- 0.8 mg/dL, respectively. The donors for preemptive and non-preemptive groups of recipients did not differ significantly in respect to age, gender, and renal function. The mean number of mismatches of 3.73 and 3.25 and the mean total ischemic times of 9.53 +/- 5 and 11.2 +/- 5 hours, in preemptive and non-preemptive groups of recipients, respectively. The incidence of delayed graft function (dialysis in the first week after transplantation) was significantly lower among preemptive recipients (20% versus 42%, respectively). The groups did not differ either in respect to the occurrence of acute rejection episodes or graft and patient survivals. In preemptive patients the mean plasma creatinine levels at 3 and 12 months were 1.37 +/- 0.3 and 1.09 +/- 0.3 mg/dL, and in non-preemptive patients 1.7 +/- 0.5 and 1.4 +/- 0.4 mg/dL. In conclusion, these results are promising, confirming the notion that preemptive kidney transplantation is the optimal treatment for end-stage renal disease patients.

Cardiovascular Effects of Successful Renal Transplantation: A 30-Month Study on Left Ventricular Morphology, Systolic and Diastolic Functions

The purpose of this study was to determine the effects of a successful renal transplantation on left ventricular (LV) morphology, systolic and diastolic function. Forty-three renal transplant patients prospectively studied by echocardiography (30 months follow-up) were divided into two groups. The first echocardiographic examination was performed 3.0 +/- 2.8 months after renal transplantation in group I (11 men, 12 women); and 34.4 +/- 29.1 months after transplant in group two (9 men, 11 women). We noticed the following changes in blood pressure (BP): group 1 systolic BP reduction (from 140.5 +/- 23.6 to 126 +/- 6.8 mmHg; P < .01), and pulse pressure reduction (from 59.5 +/- 14.9 to 47.5 +/- 9.8 P < .05); group 2, diastolic BP acceleration (from 78.4 +/- 8.7 to 84 +/- 6.9 mmHg, P < .05). LV mass index decreased in group 1 (from 126.4 +/- 18.0 g/m2 to 104.6 +/- 15.9 g/m2, P < .05). The incidence of LV hypertrophy (LVH) decreased in group 1 from 70% to 40% (P < .05). Only one parameter of systolic function-end systolic stress-significantly decreased in both groups: group 1 from 78 +/- 11 to 61 +/- 12 g/cm2; group 2 from 63.8 +/- 9.0 to 55.1 +/- 9.0 g/cm2, P < .05). The pattern of mitral inflow changed: in group 1, the normal pattern decreased from 30% to 20% and the restrictive pattern increased from 0% to 10%; in group 2, the normal mitral inflow pattern decreased from 60% to 20% and abnormal relaxation type increased from 40% to 80%. Regression of LVH after renal transplant improved LV geometry and systolic function. Despite better systolic function a progression of LV diastolic dysfunction was noticed, which might be explained by cyclosporine treatment. Renal transplantation exerted a beneficial impact on cardiomyopathy manifested by LVH and systolic dysfunction.

Influence of predialysis oxidative stress on peroxidation processes after renal transplantation

Oxidative stress occurs as a result of reactive oxygen species (ROS) overproduction. The content of carbonyl groups (CG), malonyldialdehyde, 4-hydroxynonenal (MDA, 4-HNE) represent markers of protein and lipid peroxidation processes, respectively. The aim of the present study was to determine CG and MDA/4-HNE in the serum of 30 hemodialyzed patients (-HD; 13 men, 17 women of mean age 47.7 +/- 15.3 years) before and after a hemodialysis session, of 20 transplant patients (TX; 10 men, 10 women of mean age 40.7 +/- 11.3 years) before and after the procedure (RT), and of a control group (n = 47; including 30 women, 17 men of mean age 38.7 +/- 14.0 years). The CG content was evaluated using the 2,4-dinitrophenylhydrazine assay and MDA/4-HNE by the Oxis Bioxytech colorimetric method. Among the HD group the concentrations of MDA/4-HNE and CG were higher than control subjects (P <.05). In the HD group CG concentrations before and after dialysis session were similar while MDA/4-HNE concentrations were higher before the dialysis session (P <.01). One day after RT, MDA/4-HNE and CG concentrations had increased but at 7 days they had decreased and the CG level was increased. A high production of ROS can be assumed in dialysis patients. MDA/4-HNE concentrations, however, decreased after the dialysis treatment, because as low-weight molecules they diffused across the dialysis filter. On the first day after RT a high intensity of lipid and protein peroxidation was observed. During the first week after RT, accumulation of protein peroxidation products was observed but simultaneously lipid peroxidation product concentrations decreased due to quick metabolism. The intensity of lipooxidation during first day after RT seems to be dependent upon the ischemia time.

Hemolytic anemia after renal transplantation: analysis of case reports

Hemolysis after renal transplantation in some cases is clearly related to hemolytic-uremic syndrome (HUS) and usually attributed to cyclosporine (CsA) treatment. Acute hemolysis in other recipients is related to anti-erythrocyte autoantibodies. In most cases these patients have received ABO-compatible, although ABO-nonidentical, organs, mostly from O blood group donors. We report three cases of autoimmune hemolytic anemia after renal transplantation. Two patients (patients: 1 and 2; ABO-compatible, but nonidentical kidneys) suffered acute hemolysis in the third week after transplantation. One patient (patient 3: ABO-identical kidney) suffered a chronic, subclinical course of disease beginning 5 months after transplantation. The clinical picture of this disease was completely different from HUS. The existence of severe anemia (patients 1 and 2), hyperbilirubinemia (particularly high in patient 3), increased serum lactic dehydrogenase levels, and decreased serum haptoglobin in the presence of good graft function suggested an hemolytic anemia. In all patients the direct antiglobulin test was positive. The acute or chronic symptoms of hemolysis disappeared, at 2 and 5 weeks, respectively, after conversion from CsA to tacrolimus. Hemolysis in these patients probably relates to alloantibodies derived from passenger B lymphocytes transplanted with the organs. Because hemolysis has been most frequently related to CsA therapy, it is suggested that B lymphocytes proliferated and produced antibodies because CsA effects to inhibit T-cell function generally spares B-cell activity. It is proposed that a subtype of B cells, which are resistant to CsA, produces anti-A and/or anti-B antibodies. Treatment with tacrolimus appears to be successful, probably due to its alternate, and likely more effective, manner of B-cell suppression.

Plasma carnitine profile during chronic renal anemia treatment with recombinant human erythropoietin

Recombinant human erythropoietin (epoetin) is widely used for correction of anaemia in patients with chronic renal disease and its efficacy has been confirmed in numerous studies. Disturbances in carnitine metabolism may also contribute to the development of renal anaemia. Although increases in erythrocyte count (RBC) and changes in RBC metabolism during L-carnitine administration have been observed, supplementation with L-carnitine in anaemic hemodialysis patients is not routine. The aim of our study was to determine the influence of epoetin on hematological parameters and plasma carnitine profile in anaemic hemodialysis patients. 36 hemodialysis patients (22 men, 14 female, aged from 17 to 64 years, mean 43) and 30 healthy volunteers (12 men, 18 female, aged from 25 to 65 years, mean 40) were studied. Epoetin (Eprex, Janssen-Cilag) was administered subcutaneously for twelve months with the starting dose 2000 IU three times per week (range from 75 to 133, mean 102 +/- 21 IU/kg/week). The target hemoglobin (Hb) range at the time of the study was between 10-11 g/dL. Laboratory markers of hematological response, carnitine and iron status, were measured before epoetin administration and then controlled every three months. During epoetin treatment a significant increase in Hb concentration was observed (100% of patients responded to epoetin). In the third and six month of epoetin treatment, along with a significant increase in mean reticulocyte count and the highest increment of RBC count and Hb levels, probably due to increased erythropoiesis, a significant, transient decrease of mean total and free plasma carnitine levels was observed. This may suggest the utilisation of carnitine by a new RBC population. It also indicates that there is a need for L-carnitine in carnitine deficient maintenance hemodialysis patients particularily during erythropoiesis induced by epoetin treatment.

Recombinant human erythropoietin stimulates production of interleukin 2 by whole blood cell cultures of hemodialysis patients

The impairment of function of human T lymphocytes, leading to an inappropriate cytokine production, is partially responsible for defective immunological response in hemodialysis patients (HD). Recent data suggest that recombinant human erythropoietin (rhEPO) may exert immunological effects. The aim of this study was to find out whether rhEPO treatment of the HD patients may have an effect on the interleukin 2 (IL-2) production by their whole blood cell cultures. The study was carried out in 10 HD patients receiving rhEPO for 6 months. Compared with the levels seen before the treatment, the concentration of IL-2 increased in the phytohemagglutinin-stimulated whole blood cell cultures of 7 of 10 patients under study. Addition of rhEPO in vitro to the whole blood cell cultures of the HD patients before implementation of erythropoietin confirmed that rhEPO is able to directly stimulate IL-2 production. Our studies show that the therapy with rhEPO affects IL-2 secretion.

The influence of recombinant human erythropoietin on tumor necrosis factor alpha and interleukin-10 production by whole blood cell cultures in hemodialysis patients

Impaired immunological response in hemodialysis (HD) patients, which leads to inappropriate cytokine production, is partially caused by the hyperstimulation of both T lymphocytes and monocytes/macrophages. Recent data suggest that human recombinant erythropoietin (rhEPO) may have an immunological action. The goal of our study was to estimate the influence of rhEPO treatment on the production of the inflammatory cytokine tumor necrosis factor alpha (TNFalpha) and antiinflammatory cytokin interleukin-10 (IL-10) in 10 HD patients receiving rhEPO for 6 months. The levels of cytokines were measured in the in vitro cultures of whole blood. The level of IL-10 increased in all treated patients during the therapy, and it was accompanied by a transitory decrease of TNFalpha. The results of our studies suggest that rhEPO may reduce the inflammatory process by decreasing production of TNFalpha and increasing production of IL-10.

[The effect of administering Omega-3 acids on lipids in serum, functional state of erythrocyte membrane and function of the kidneys in patients with primary glomerulonephritis]

There are reports concerning profitable influence of unsaturated acids administration on blood pressure, inflammation and proteinuria. The aim of presented study was to estimate the effect of Omega-3 on plasma lipids and renal function in patients with primary glomerulopathies. The tested group consisted of 13 patients (7F and 6M) aged from 22 to 60 years, with primary glomerulopathies and normal renal function. They received Omega-3 (Fishproduct, iceland) 3 x 2 caps for three months. Before, after 2 and 3 months of treatment and 3 months after its discontinuation following parameters were estimated: total cholesterol, HDL and LDL cholesterol (HDL, LDL), triglycerides and an order parameter of erythrocyte lipid bilayer (S). Simultaneously N-acetylglutamate (NAG), creatinine clearance and 24-hours proteinuria were measured. For calculation t-Student test was used. In our study we found statistically significant increase of HDL after 2 and 3 months and decrease of LDL after 3 months of Omega-3 administration (p < 0.05). During the 2 and 3 months of treatment statistically significant decrease of NAG was noticed but a month after its discontinuation significant increase of NAG excretion was observed (p < 0.05). The S parameter in tested group of patients was higher than in healthy population but during Omega-3 administration the value of an order parameter of erythrocyte bilayer increased significantly (p < 0.01). On the base of given results we could conclude that unsaturated acids may have profitable influence on plasma lipids, functional status of erythrocyte membrane and probably proximal tubule function in patients with primary glomerulopathies.

[Does erythropoietin treatment influence the lipid status of patients on maintenance hemodialysis?]

Plasma lipid disturbances are common among patients on maintenance haemodialysis and it seems to be important to evalate lipid status on r-Epo since this treatment of anemia is becoming substantial and so often used in that population. It appears more valuable because there are controversial data in the literature concerning this problem. The aim of the present study was to measure changes in serum lipid concentration in two comparable groups: I--11 patients (7f, 4m) aged 47 +/- 8 years receiving r-Epo s.c. during at least 6 months before HD and 2 years of HD with initial dose 3 x 50 u/kg b.w. and II--18 patients (7f, 11m) aged 45 +/- 8 years without r-Epo in that period of time. Following parameters were estimated every two months: total cholesterol (CH-C), HDL cholesterol (HDL-CH), LDL cholesterol (LDL-CH), triglycerides (TG), apolipoprotein B (Apo B).

CONCLUSIONS

1. Subcutaneous therapy with r-Epo is an effective method of treatment of anemia in dialysis patients. 2. Long-term r-Epo treatment does not permanently influence the blood lipid profile in hemodialysed patients.

[Effect of human recombinant erythropoietin (r-EPO) on behavior of iron status parameters in patients with chronic renal failure treated with dialysis]

For proper erythropoietic response to r-Epo iron, folic acid and B12 vitamin are needed. Iron deficiency is the most common in uremic patients treated with r-Epo. So the aim of presented study was to measure hematological and iron status changes. Studies were carried out in 23 anemic, uremic, hemodialysis patients. They were divided into two groups, the first HDa--5 people (3W, 2M) aged 23-49 (mean 34 +/- 12) years and the second HDb 18 patients (11W, 7M) aged 21-56 (mean 38 +/- 12) years. Mean hemoglobin (HGB) before r-Epo was 6.9 +/- 1.0 g/dl in HDa, and 6.7 +/- 1.1 g/dl in HDb. r-Epo in HDa group was given during 12 weeks i.v. and afterwards s.c. for other 4 weeks with initial dose 3 x 50 u/kg b.w. (mean during 4 months 65 +/- 24 u/kg m.c. 3 times weekly). Patients from HDb group received r-Epo during 12 months only s.c. with initial dose 2000 u three times per week (mean during 12 months 26 +/- 4 u/kg m.c. 3 times weekly). Dose of r-Epo was changed accordingly to HGB concentration to keep it between 10-12 g/dl. Blood morphological parameters were monitored weekly using hematological autoanalyser Technicon H1, simultaneously an iron status indicators as iron, transferrin and ferritin were measured. An increase of HGB concentration, erythrocytes count and Ht value was observed in all patients (I-HGB 10.1 +/- 2.9, II-HGB 9.2 +/- 1.6).(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of treatment with erythropoietin (r-EPO) on hemodynamics of the cardiovascular system in patients with chronic renal failure (c.r.f.)]

Patients with chronic renal failure (c.r.f.) are at high risks of death from cardiovascular diseases. It was found that successful treatment of anemia could positively influence not only patients well being but also caused some unfavourable hemodynamic changes. The aim of the study was the estimation of some morphological and functional parameters of left ventricle (lv) in dialyzed and predialyzed patients treated with r-Epo. Two groups of patients with c.r.f. were studied. The I group of 10 dialyzed patients (6 W, 4 M, mean age 34 +/- 11, weight 55 +/- 9 kg), and the II group of 9 pre-dialyzed patients (6 W, 3 M, mean age 50.6 +/- 10, weight 63 +/- 14 kg). r-Epo (Eprex Cilag AG) was administered during 6 months s.c. The I group was given initial dose 3 x 2000 u per week (mean dose 24-46 u/kg b.w./per week, the II was on 3 x 2000 u per week (mean dose 24-46 u/kg b.w./per week) subcutaneously. The doses were adjusted by Hb level in order to keep it within limits (10-12 g/dl). Hematological parameters were monitored once a week by Technicon H1. Morphology and function of the lv were evaluated using echocardiographic measurements performed by Irex IIIA system. According to prescriptions of ASE the following parameters have been assessed: lv dimension, thickness of posterior wall in diastole and systole and thickness of interventricular septum in diastole.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of erythropoiesis under the influence of recombinant human erythropoietin (R-EPO) in dialyzed patients]

5 deeply anemic (Hb less than 8 g/dl, Ht less than 25%) dialyzed patients with chronic renal failure were treated during four months with r-Epo. Blood cells morphological parameters were estimated using hematological autoanalyser Technicon H1. Satisfactory increase of the Hb levels and RBC counts were observed in 4 patients, in one the improvement was insignificant. We observed three types of response to r-Epo treatment: 1) macrocytic type, 2) hypochromic type, and 3) non-hypochromic type, without lasting macrocytosis. Our results suggest that type of erythropoiesis depends on other active biological substances (iron, folic acid, vit. B12) necessary for correcting erythropoiesis. r-Epo administration appeared to be a safe and effective method of anaemia treatment in dialyzed patients. Its administration eliminated blood transfusion for six months.

[Subcutaneous administration of recombinant human erythropoietin (R-EPO) in the treatment of anemia in predialysis patients with chronic renal failure]

10 anemic (HB less than 9.0 g/dl) predialysis patients with chronic renal failure were treated for three months with s.c. administration of r-Epo. Blood morphological parameters were estimated using hematological autoanalyser Technicon H1. An increase of the mean hemoglobin (Hb) level from 8.39 to 10.57 g/dl was observed. In 8 patients Hb concentration after 3 months therapy ranged from 9.4 to 12.7 g/dl, but in the remaining two of them Hb was lower than 9.0 g/dl. Appearance of a high percentage of hypochromic erythrocytes is probably the most characteristic response to r-Epo treatment. This phenomenon was caused by iron deficiency. A significant increase of serum creatinine and BUN levels were observed in treated patients, without the concomitant decrease of endogenous creatinine clearance. No clinical symptoms suggesting deterioration of the renal function were observed. Subcutaneous therapy with r-Epo appeared an effective and convenient method of treatment of anemia in predialysis patients.

[Nephrotoxicity of gentamycin used in hepatic and biliary diseases]

Authors discuss nephrotoxicity of aminoglycosides in patients with hepatic and biliary disorders. It may be concluded that hepatic and biliary diseases should be considered as an additional gentamycin nephrotoxicity risk factor. Administration of gentamycin to such patients require dose adjustments to renal function and--if possible--to gentamycin serum level.