Aluminium Interference in the Treatment of Haemodialysis Patients with Recombinant Human Erythropoietin

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Abstract
In nine chronic haemodialysis patients a desferioxamine (DFO) load test (40 mg/kg body-weight) was performed 1 year after the beginning of treatment with recombinant human erythropoietin (rHuEpo). The patients were then divided into two groups. Group A comprised five patients with a greater mean aluminium (204 .+-. 28 .mu.g/l) than the four patients in group B. Group A was given a mean dose of 25.8g (range 14-39g) of DFO over 6 months. Group B (aluminium values 112 .+-. 36 .mu.g/l) was never treated with DFO. During the period of observation, plasma iron, serum ferritin and transferrin, as well as iron supplementation, did not differ between the groups. After DFO treatment a second DFO load test was performed. The mean predialysis aluminium value was significantly reduced in group A (204 .+-. 28 vs 111 .+-. 72 .mu.g/l; P < 0.05), while remaining unchanged in group B (112 .+-. 36 vs 140 .+-. 39 .mu.g/l; P = ns). In both groups, the doses of rHuEpo necessary to maintain the same haemoglobin values decreased with time, but reduced significantly only in group A (298 .+-. 105 vs 110 .+-. 61 .mu./kg per week; .DELTA. -63%; P < 0.01). Thus, aluminium interferes with the response to rHuEpo in haemodialysis patients, and the correction of aluminium overload with DFO can allow a considerable sparing of rHuEpo.