The Effect of Recombinant Hump Erythropoietin Therapy in Anemic Kidney Patients: A Nutritional Emphasis
Abstract Erythropoietin (EPO) is a hormone critical to erythroid development. Produced in the kidney, EPO stimulates erythroid precursors, regulates hemoglobin synthesis, and accelerates the production of red blood cells. During normal renal function EPO production increases with anemic conditions. In contrast, the damaged kidney of end-stage renal disease (ESRD) is unable to maintain this homeostatic balance. Thus, as kidney failure progresses, the severity of anemia increases. The recent development of recombinant human erythropoietin (r-HuEPO) brings hope to the hemodialysis population suffering from ESRD-associated anemia. Clinical trials indicate that several biochemical, hematological, and physiological parameters are improved with r-HuEPO therapy. The quality of life for patients is improved with r-HuEPO treatment; they report increased energy and appetite. The requirements of several nutrients important to erythropoiesis are increased as a result of r-HuEPO therapy. Serum concentrations of iron, folate, and vitamin B 12 should be monitored during treatment, and supplementation is often recommended. Hematocrit is increased with treatment of r-HuEPO. Amino acid concentrations may improve with r-HuEPO therapy. The blood levels of several minerals may become altered in the hemodialysis patient receiving r-HuEPO therapy. Hyperkalemia has been observed in some patients. Elevated aluminum blood levels interfere with erythropoiesis and ferrokinetics; however, desferrioxamine therapy has been used to treat this condition. Major advances have been made in treating the anemia of renal failure; however, the nutritional requirements of r-HuEPO patients warrant further investigation.