ERYTHROPOIETIN DOSE: DETERMINED BY THE GENES?

摘要

The individual dose of erythropoietin required to correct renal failure-associated anemia is very variable and has been shown to be related to a number of clinical factors, including iron status, infection, blood Loss, parathyroid status, and dialysis adequacy (1). It is also well known from both clinicaland in vitro studies thatinf lam-matorycytokines, suchasinterferon-gamma and tumor necro-sis factor alpha (TNF-alpha), inhibit erythropoiesis and are associated with erythropoietin resistance (2,3). Angio-tensin II is also involved in erythropoietin responsiveness. In vitro studies have shown that angiotensin II directly increases the proliferation of erythroid progenitors (4), and that infusion of angiotensin II into mice without angiotensin-converting enzyme (ACE) will correct their anemia (5). In patients, the data are more variable, depending on the size of the study and the drug dose used, but it would appear that high doses of ACE inhibitors or angiotensin II receptor blockers will blunt the response to erythropoietin (6).