Effect of Recombinant Human Erythropoietin on Nutritional Status and Plasma Lipids in Uremic Patients

Dr. Béatrice Viron, Service de Néphrologie, Hôpital Tenon, 4, rue de la Chine, F-75020 Paris (France) Dear Sir, Improved appetit and food intake have been reported from earlier studies of patients treated with recombinant human erythro-poietin (r-Hu EPO) [1]. An increase in BUN, plasma creatinine and plasma phosphorus values as well as, in some cases, severe hyper-kaliemia were observed in certain series [2]. Contrasting with their generally poor nutritional status [3], plasma lipid abnormalities are common in uremic patients [4], especially those maintained on hemodialysis (HD) or peritoneal dialysis (PD). In those patients, particularly prone to diffuse atherosclerosis [5], any deleterious effect of r-Hu EPO on plasma lipids might question the benefit of correcting anemia with this treatment. However, the effect on plasma lipids of the r-Hu-EPO-induced changes concerning the nutritional behavior of uremic patients had not been assessed yet. We have studied 12 patients, 7 HD (4 males, 3 females, mean age 57) and 5 PD (3 males, 2 females, mean age 70). Plasma lipids were measured together with different reliable parameters of the nutritional status [3], first, before initiating r-Hu EPO, then 6 months from the date of correction of anemia (defined as Hb > 10 g/dl). The following data were collected: body mass index, triceps skin-fold thickness (TST), arm muscle circumference (AMC), serum albumin, prealbumin, transferrin, total cholesterol, triglycerides (Tg), apolipoprotein (Apo) Al, Apo B, retinol-binding protein and acid αΓglycopro-tein. These values were compared to those obtained from 7 HD and 12 PD nonanemic patients, matched for age, sex and duration of maintenance dialysis. Before EPO, Hb was 7.2 ± 0.4 g/dl in the HD and 8.6 ± 0.7 g/dl in the PD patients. The PD patients had decreased serum albumin (2.9 ± 0.4 g/dl), increased Tg (2.3 ± 1.4 mmol/ 1) and Apo B (0.16 ± 0.05 g/dl), whereas only Tg were abnormally high (2.0 ± 1.1 mmol/l) in HD patients. However, anthropometric hallmarks of malnutrition were exclusively found in male HD patients, who had low values of body mass index (20.9 ± 1.0 kg/m2), TST (4.2 ± 1.1 mm) and AMC (22.4 ± 2.7 cm). After 6 months with stable Hb (HD: 10.4 ± 0.8 g/dl; PD: 10.1 ± 0.6 g/dl), only the male HD patients exhibited a significant increase in TST (5.1 ± 1.2 mm; p < O.Ol) and AMC (23.1 ±