Prevalence of Anti-Erythropoietin Antibodies in Hemodialysis Patients without Clinical Signs of Pure Red Cell Aplasia

Vol. 105, No. 2, 2007

Free Abstract Article (Fulltext) Article (PDF 196 KB)

Original Paper

Prevalence of Anti-Erythropoietin Antibodies in Hemodialysis Patients without Clinical Signs of Pure Red Cell Aplasia
Comparison between Hypo- and Normoresponsive Patients Treated with Epoetins for Renal Anemia
Markus P. Stoffel^a, Heinz Haverkamp^b, Arno Kromminga^c, Karl W. Lauterbach^b, Conrad A. Baldamus^a

^aDepartment of Internal Medicine, Division of Nephrology, University Hospital of Cologne,
^bInstitute of Health Economics, University of Cologne, Cologne, and
^cInstitute of Immunology, Clinical Pathology, Molecular Medicine, Hamburg, Germany

Address of Corresponding Author

Nephron Clin Pract 2007;105:c90-c98 (DOI: 10.1159/000097889)

Key Words

Anti-erythropoietin antibody
Erythropoietin
Hemodialysis
Pure red cell aplasia
Anemia
Anti-epoetin antibodies
Chronic kidney disease
Immunogenicity

Abstract

Background/Aims: The prevalence of anti-erythropoietin antibodies in renal patients without clinical evidence of pure red cell aplasia (PRCA) who respond poorly to epoetin is unknown. This study tested for anti-erythropoietin antibodies in hemodialysis patients who were either hypo- or normoresponsive to epoetin treatment. Methods: Epoetin hyporesponsiveness (hemoglobin 10.5 g/dl and epoetin 9,000 IU/week) and normoresponsiveness (hemoglobin >10.5 g/dl and epoetin <7,000 IU/week) were arbitrarily defined. Prevalence of anti-erythropoietin antibodies in hemodialysis patients without symptoms of PRCA was determined by screening sera of 536 patients from 35 German KfH dialysis units, using enzyme-linked immunosorbent assay (ELISA). Positive results were verified by radioimmunoprecipitation assay (RIP) and neutralizing activity was determined by bioassay. Results: Anti-erythropoietin antibodies were detected in 3 hyporesponsive and 3 normoresponsive patients using ELISA. One patient per group was verified as borderline by RIP testing; the other 4 were negative. The bioassay was negative for 1 patient; the other died unrelated to PRCA before testing. Follow-up with RIP testing after 15 months under continuous epoetin treatment was negative (4 patients, 2 deceased). Conclusion: This survey did not identify anti-erythropoietin antibodies in hemodialysis patient's hyporesponsive to epoetin and does not support presumptive antibody screening as a routine work-up in these patients.

Author Contacts

Markus P. Stoffel, MD
QiN-Gruppe/IGKE
Gleueler Strasse 176
DE-50935 Cologne (Germany)
E-Mail drmstoffel@yahoo.de

Article Information

Received: July 22, 2005
Accepted: June 19, 2006
Published online: December 12, 2006
Number of Print Pages : 9
Number of Figures : 1, Number of Tables : 3, Number of References : 26

Medline Abstract (ID 17164586)

Download Citation

For non-native English speakers and international authors who would like assistance with their writing before submission, we suggest American Journal Experts for their scientific editing service.