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01-11-2018 | Original Article

Response to erythropoietin in pediatric patients with chronic kidney disease: insights from an in vitro bioassay

Authors: Rachel Gavish, Salmas Watad, Nathalie Ben-Califa, Ori Jacob Goldberg, Orly Haskin, Miriam Davidovits, Gili Koren, Yafa Falush, Drorit Neumann, Irit Krause

Published in: Pediatric Nephrology | Issue 11/2018

Abstract

Background

Decreased production of erythropoietin (EPO) is a major cause of anemia associated with chronic kidney disease (CKD). Treatment with recombinant human EPO (rHuEPO) improves patients’ quality of life and survival; however, there is a marked variability in response to rHuEPO. At present, no available laboratory test is capable of evaluating responsiveness to EPO treatment. The aim of the present study was to use an in vitro bioassay to estimate the effect of uremic environment on EPO-dependent erythroid cell proliferation.

Methods

EPO-dependent human erythroleukemia cells (UT-7) were incubated with exogenous EPO (2 u/ml) and sera obtained from 60 pediatric patients (aged 1–23 years). Three groups were studied: (1) 12 children on dialysis (4 peritoneal, 8 hemodialysis); (2) 28 patients with CKD 1–5 (not on dialysis), and (3) 20 healthy children.

Results

Sera from dialysis patients inhibited UT-7 cell growth compared to the CKD group and healthy controls at 48 h (p = 0.003 and p = 0.04, respectively) and 72 h of culture (p = 0.02 and p = 0.07, respectively). In 18 patients treated with rHuEPO, a significant inverse correlation was found between the EPO resistance index and cell proliferation at 48 h (p = 0.007, r = − 0.63) and 72 h (p = 0.03, r = − 0.52).

Conclusions

Our findings support the presence of erythropoiesis inhibitory substances in uremic sera. EPO/EPO-R-dependent mechanisms may play a role in inhibiting erythropoiesis. The in vitro bioassay described herein may serve as an indicator of rHuEPO responsiveness which may encourage further investigation of underlying mechanisms of EPO resistance.

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Title: Response to erythropoietin in pediatric patients with chronic kidney disease: insights from an in vitro bioassay
Authors: Rachel Gavish
Salmas Watad
Nathalie Ben-Califa
Ori Jacob Goldberg
Orly Haskin
Miriam Davidovits
Gili Koren
Yafa Falush
Drorit Neumann
Irit Krause
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 11/2018
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-018-4016-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Response to erythropoietin in pediatric patients with chronic kidney disease: insights from an in vitro bioassay

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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