Timing and Determinants of Erythropoietin Deficiency in Chronic Kidney Disease

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Summary: Background and objectives: Anemia in patients with CKD is highly related to impaired erythropoietin (EPO) response, the timing and determinants of which remain unknown. Design, setting, participants, & measurements: This study measured EPO levels and studied their relation to GFR measured by 51Cr-EDTA renal clearance (mGFR) in 336 all-stage CKD patients not receiving any erythropoiesis-stimulating agent. Results: In patients with anemia defined by World Health Organization criteria (hemoglobin [Hb] 30 ml/min per 1.73 m2, whereas they were not correlated when mGFR was r=0.09, P=0.3; P for interaction=0.01). In patients with anemia, the ratio of observed EPO to the level predicted by the equation for their Hb level decreased from 0.72 (interquartile range, 0.57–0.95) for mGFR ≥60 ml/min per 1.73 m2 to 0.36 (interquartile range, 0.16–0.69) for mGFR 30 ml/min per 1.73 m2 calls for other explanatory factors.

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