Calcitriol increases burst-forming unit-erythroid proliferation in chronic renal failure. A synergistic effect with r-HuEpo.
Nephron Clin Pract
; 95(4): c121-7, 2003.
Article
em En
| MEDLINE
| ID: mdl-14694273
ABSTRACT
BACKGROUND:
Calcitriol (C) improves anemia in chronic renal failure. This effect may be related to the suppression of iPTH release, or to a direct effect on erythropoiesis.METHODS:
Thirty-three patients with chronic renal failure were enrolled; among them, 24 were on chronic hemodialysis and 9 on conservative management. None had other chronic or hematological disease, aluminum levels were below 20 microg/l and DFO testing was negative. The iPTH range was 250-480 pg/l. None were treated with C or r-HuEpo. In vitro study Samples were drawn for a basal erythroid precursor (burst forming unit-erythroid BFU-E) study Mononuclear cells were incubated for 14 days with r-HuEpo 3U/ml (A), r-HuEpo 3U/l + C 30 pg (B), r-HuEpo 3U/ml + C 300 pg (C), or r-HuEpo 30 U/ml + C 300 pg (D). In vivo study After the basal evaluation, 10 patients on chronic dialysis were treated with C (Calcijex-Abbott) 1 microg three times a week, and 4 patients served as controls. BFU-E studies were performed after 1, 2 and 4 months.RESULTS:
In vitro, culture B showed increased BFU-E proliferation vs. A (41 +/- 23 vs. 27 +/- 15, p < 0.02); in cultures C and D, proliferation was 61 +/- 31 and 78 +/- 42, respectively, p < 0.01 vs. A. There was no difference among patients with predialysis renal failure and those on dialysis. BFU-E proliferation was inversely related to basal Hb (p < 0.04) and CRP levels (p < 0.05). During the in vivo study, all cultures showed a progressive increase in proliferation without a plateau level (basal, after 1, 2 and 4 months, respectively) In A 17 +/- 8, 22 +/- 13, 30.9 +/- 14.9, 41.4 +/- 20; in B 27.3 +/- 15, 35.6 +/- 20, 45.5 +/- 21, 57 +/- 26; in C 48.2 +/- 20.6, 63.7 +/- 32, 75.7 +/- 37, 83 +/- 40; in D 72 +/- 24, 91 +/- 42, 106 +/- 42, 110 +/- 42.3 (all p < 0.001). Hb and Hct showed a significant increase (p < 0.03) in the treatment group. The decrease in iPTH was not related to BFU-E proliferation.CONCLUSIONS:
In chronic uremia, C has a direct effect on erythroid precursors proliferation, as demonstrated both in vitro and in vivo, with a synergistic effect with r-HuEpo. C may be a useful adjuvant therapy to r-HuEpo treatment.
Buscar no Google
Base de dados:
MEDLINE
Assunto principal:
Calcitriol
/
Células Precursoras Eritroides
/
Eritropoetina
/
Células Eritroides
/
Falência Renal Crônica
Limite:
Humans
/
Middle aged
Idioma:
En
Ano de publicação:
2003
Tipo de documento:
Article