Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance?
Background/Objectives Translocated endotoxin derived from intestinal bacteria is a driver of systemic inflammation and oxidative stress. Severe endotoxaemia is an underappreciated, but characteristic finding in haemodialysis (HD) patients, and appears to be driven by acute repetitive dialysis i...
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| Format: | Article |
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Public Library of Science
2012
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| Online Access: | https://eprints.nottingham.ac.uk/2336/ |
| _version_ | 1848790758365069312 |
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| author | Harrison, Laura E.A. Burton, James O. Szeto, Cheuk-Chun Li, Philip K.T. McIntyre, Christopher W. |
| author_facet | Harrison, Laura E.A. Burton, James O. Szeto, Cheuk-Chun Li, Philip K.T. McIntyre, Christopher W. |
| author_sort | Harrison, Laura E.A. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background/Objectives
Translocated endotoxin derived from intestinal bacteria is a driver of systemic inflammation and oxidative stress. Severe endotoxaemia is an underappreciated, but characteristic finding in haemodialysis (HD) patients, and appears to be driven by acute repetitive dialysis induced circulatory stress. Resistance to erythropoietin (EPO) has been identified as a predictor of mortality risk, and associated with inflammation and malnutrition. This study aims to explore the potential link between previously unrecognised endotoxaemia and EPO Resistance Index (ERI) in HD patients.
Methodology/Principal Findings
50 established HD patients were studied at a routine dialysis session. Data collection included weight, BMI, ultrafiltration volume, weekly EPO dose, and blood sampling pre and post HD. ERI was calculated as ratio of total weekly EPO dose to body weight (U/kg) to haemoglobin level (g/dL). Mean haemoglobin (Hb) was 11.3±1.3 g/dL with a median EPO dose of 10,000 [IQR 7,500–20,000] u/wk and ERI of 13.7 [IQR 6.9–23.3] ((U/Kg)/(g/dL)). Mean pre-HD serum ET levels were significantly elevated at 0.69±0.30 EU/ml. Natural logarithm (Ln) of ERI correlated to predialysis ET levels (r = 0.324, p = 0.03) with a trend towards association with hsCRP (r = 0.280, p = 0.07). Ln ERI correlated with ultrafiltration volume, a driver of circulatory stress (r = 0.295, p = 0.046), previously identified to be associated with increased intradialytic endotoxin translocation. Both serum ET and ultrafiltration volume corrected for body weight were independently associated with Ln ERI in multivariable analysis.
Conclusions
This study suggests that endotoxaemia is a significant factor in setting levels of EPO requirement. It raises the possibility that elevated EPO doses may in part merely be identifying patients subjected to significant circulatory stress and suffering the myriad of negative biological consequences arising from sustained systemic exposure to endotoxin. |
| first_indexed | 2025-11-14T18:17:42Z |
| format | Article |
| id | nottingham-2336 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T18:17:42Z |
| publishDate | 2012 |
| publisher | Public Library of Science |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-23362020-05-04T16:33:20Z https://eprints.nottingham.ac.uk/2336/ Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? Harrison, Laura E.A. Burton, James O. Szeto, Cheuk-Chun Li, Philip K.T. McIntyre, Christopher W. Background/Objectives Translocated endotoxin derived from intestinal bacteria is a driver of systemic inflammation and oxidative stress. Severe endotoxaemia is an underappreciated, but characteristic finding in haemodialysis (HD) patients, and appears to be driven by acute repetitive dialysis induced circulatory stress. Resistance to erythropoietin (EPO) has been identified as a predictor of mortality risk, and associated with inflammation and malnutrition. This study aims to explore the potential link between previously unrecognised endotoxaemia and EPO Resistance Index (ERI) in HD patients. Methodology/Principal Findings 50 established HD patients were studied at a routine dialysis session. Data collection included weight, BMI, ultrafiltration volume, weekly EPO dose, and blood sampling pre and post HD. ERI was calculated as ratio of total weekly EPO dose to body weight (U/kg) to haemoglobin level (g/dL). Mean haemoglobin (Hb) was 11.3±1.3 g/dL with a median EPO dose of 10,000 [IQR 7,500–20,000] u/wk and ERI of 13.7 [IQR 6.9–23.3] ((U/Kg)/(g/dL)). Mean pre-HD serum ET levels were significantly elevated at 0.69±0.30 EU/ml. Natural logarithm (Ln) of ERI correlated to predialysis ET levels (r = 0.324, p = 0.03) with a trend towards association with hsCRP (r = 0.280, p = 0.07). Ln ERI correlated with ultrafiltration volume, a driver of circulatory stress (r = 0.295, p = 0.046), previously identified to be associated with increased intradialytic endotoxin translocation. Both serum ET and ultrafiltration volume corrected for body weight were independently associated with Ln ERI in multivariable analysis. Conclusions This study suggests that endotoxaemia is a significant factor in setting levels of EPO requirement. It raises the possibility that elevated EPO doses may in part merely be identifying patients subjected to significant circulatory stress and suffering the myriad of negative biological consequences arising from sustained systemic exposure to endotoxin. Public Library of Science 2012-06-29 Article PeerReviewed Harrison, Laura E.A., Burton, James O., Szeto, Cheuk-Chun, Li, Philip K.T. and McIntyre, Christopher W. (2012) Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? PLoS ONE, 7 (6). e40209/1-e40209/5. ISSN 1932-6203 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040209 doi:10.1371/journal.pone.0040209 doi:10.1371/journal.pone.0040209 |
| spellingShingle | Harrison, Laura E.A. Burton, James O. Szeto, Cheuk-Chun Li, Philip K.T. McIntyre, Christopher W. Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? |
| title | Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? |
| title_full | Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? |
| title_fullStr | Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? |
| title_full_unstemmed | Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? |
| title_short | Endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? |
| title_sort | endotoxaemia in haemodialysis: a novel factor in erythropoetin resistance? |
| url | https://eprints.nottingham.ac.uk/2336/ https://eprints.nottingham.ac.uk/2336/ https://eprints.nottingham.ac.uk/2336/ |