Relationship between inflammatory cytokines and cardiorenal anemia syndrome:Treatment with recombinant human erythropoietin (rhepo)

Hippokratia 2008, 12(3):153-156

G. Perunicic-Pekovic, S. Pljesa, S. Rasic, L J. Komadina, R. Markovic, L J. Lambic, D. Celeketic


Background and aim: Hemodialysis (HD) patients are exposed to persistent inflammatory state. Erythropoietin resistance is known to be strongly associated with chronic inflammation. Aim of the study was to analyze the effect of elevated inflammatory markers on hemoglobin levels and rhEPO requirements in stable patients of our hemodialysis center.
Patients and methods: The study population consisted of 42 patients, 19F/23M, mean age 54.5±12.0 years. C-reactive protein (CRP), interleukin-6 (IL-6), hemoglobin (Hb), ferritin and left ventricular mass index (LVMi) were recorded. Group 1 consisted of 10 patients with Hb ≤ 10 g/dl, mean 8.3±1.2 g/dl and Group 2, of 10 patients with Hb ≥ 10 g/dl, mean 12.6±1.91 g/dl. None of these 20 patients had been previously treated with rhEPO. Group 3 consisted of 22 patients with mean Hb 10.1±1.5 g/dl after treatment with rhEPO.
Results: Group 1 patients had significanty higher IL-6 concentrations than Group 2 (5.21±3.94 vs 3.03±3.64, p < 0.03). Group 3, treated with rhEPO had IL-6 concentrations significantly lower compared to Group 1 (1.15±3.81 vs 3.03±3.64, p < 0.05). HD pts in Group 1 presented significantly higher CRP concentrations compated to pts of Group 2 and 3 (23.1±9.1 vs 7.02±8.7 and 7.89±9.6 respectivly, p < 0.05). A negative correlation was demonstrated between IL-6 and Hb level (r: 0.33 p < 0.05).
Conclusions: A better management of anemia might improve inflammatory state and survival in this population.