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

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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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Acknowledgments

The authors thank Mrs. Phyllis Curchack Kornspan for her editorial services.

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Author notes

  1. Rachel Gavish, Salmas Watad, Drorit Neumann and Irit Krause contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, 14 Kaplan St., Petah Tikva, Israel

    Rachel Gavish, Salmas Watad, Ori Jacob Goldberg & Irit Krause

  2. Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Nathalie Ben-Califa & Drorit Neumann

  3. Institute of Pediatric Nephrology, Schneider Children’s Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Orly Haskin, Miriam Davidovits, Gili Koren & Yafa Falush

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  1. Rachel Gavish
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Correspondence to Irit Krause.

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Gavish, R., Watad, S., Ben-Califa, N. et al. Response to erythropoietin in pediatric patients with chronic kidney disease: insights from an in vitro bioassay. Pediatr Nephrol 33, 2123–2129 (2018). https://doi.org/10.1007/s00467-018-4016-1

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  • DOI: https://doi.org/10.1007/s00467-018-4016-1

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