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Dr. Hjalmar B. Steinhauer, Medizinische Universitätsklinik, Abteilung Nephrologie, Hugstetter Strasse 55, D-7800 Freiburg, (FRG) Dear Sir, Recombinant human erythropoietin (rHuEPO) has been shown to be effective in correcting renal anemia of patients with chronic renal failure undergoing hemodial-ysis [1–4]. Despite that anemia is usually less severe in patients on continuous ambulatory peritoneal dialysis (CAPD) compared to hemodialysis, the correction of anemia will improve the clinical condition of CAPD patients. In order to study the effect of rHuEPO on anemia and peritoneal dialysis efficiency, 8 CAPD patients (agend 26–67 years) were treated with rHuEPO (Cilag Ltd., Schaffhausen, Switzerland) subcutaneously twice weekly with an initial dose of 50 U/kg body weight. Every 4 weeks the rHuEPO dose was increased for 25 U/kg body weight till the target hematocrit (HKT) of 35% had been achieved. In case this HKT was exceeded, rHuEPO was reduced by 25 U/kg body weight. CAPD study exchanges with 4 h dwell time were performed twice weekly in the morning with 1.5 liters 1.5% dextrose monohydrate (Fresenius AG, Bad Homburg, FRG; Baxter, Deerfield, Ill., USA). Subcutaneous administration of rHuEPO was tolerated without severe side effects (short-lasting local pain after subcutaneous injection in 4 patients, increased anti-hypertensive treatment in 2 patients, transient flu-like syndrome in 1 patient). The result are summarized in table 1. RHuEPO-induced correction of anemia was associated with increased peritoneal ultrafiltration (UF). UF/4 h dwell time rose from 156 ± 105 to 264 ± 138 ml after 12 weeks of rHuEPO treatment. Urea clearance increased from 5.5 ± 0.8 to 6.3 ± 1.5 ml/min/1.73 m2. Since urea serum and dialysate concentrations remained unchanged, the augmented clearance of urea is due to the rise in UF. Increased peritoneal UF can be achieved by (1) augmented mesenteric blood flow, (2) rised peritoneal permeability, (3) decreased lymphatic absorption from the abdominal cavity, and (4) increased osmotic gradient between dialysis solution and plasma [5,6]. RHuEPO-induced correction of anemia may rise mesenteric perfu-sion by improved cardiac function [7,8]. A corresponding observation was described in CAPD patients with congestive heart disease after effective digitalis therapy [9]. No data are available on the effect of anemia correction on peritoneal transport, peritoneal lymphatic absorption and osmotic gradient.

Increased Ultrafiltration after Erythropoietin-Induced Correction of Renal Anemia in Patients on Continuous Ambulatory Peritoneal Dialysis