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

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

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...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) Vol. 33; no. 11; pp. 2123 - 2129
Main Authors: Gavish, Rachel, Watad, Salmas, Ben-Califa, Nathalie, Goldberg, Ori Jacob, Haskin, Orly, Davidovits, Miriam, Koren, Gili, Falush, Yafa, Neumann, Drorit, Krause, Irit
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2018
Springer
Springer Nature B.V
Subjects:
Bioassays
Care and treatment
Cell culture
Cell growth
Cell proliferation
Children
Chronic kidney failure
Complications and side effects
Development and progression
Erythroleukemia
Erythropoiesis
Erythropoietin
Health aspects
Hemodialysis
Kidney diseases
Kidneys
Medicine
Medicine & Public Health
Nephrology
Original Article
Patients
Pediatric anemia
Pediatrics
Peritoneum
Quality of life
Recombinant erythropoietin
Risk factors
Urology
What’s New in Chronic Kidney Disease
Dialysis
UT-7 cells
Anemia
Pediatric
Erythropoietin resistance index
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Summary: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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ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-018-4016-1