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This Article Full Text (Rapid PDF) Supplemental Data All Versions of this Article: ASN.2009040400v1 ASN.2009040400v2    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Betjes, M. G.H. Articles by Litjens, N. H.R. PubMed PubMed Citation Articles by Betjes, M. G.H. Articles by Litjens, N. H.R.

CMV Seropositivity Determines Epoetin Dose and Hemoglobin Levels in Patients with CKD

Department of Internal Medicine, Division of Nephrology, Erasmus Medical Center, Rotterdam, Netherlands

Correspondence: Dr. Michiel G.H. Betjes, Erasmus Medical Center, Department of Internal Medicine, Division of Nephrology, Dr. Molewater plein 40, 3015 GD Rotterdam, Netherlands. Phone: 31-10-7040704; Fax: 31-10-7035756; E-mail: m.g.h.betjes{at}erasmusmc.nl

Received for publication April 15, 2009. Accepted for publication August 13, 2009.

Cytomegalovirus (CMV)-seropositive patients with ESRD may have more CD4⁺ T cells lacking the co-stimulatory molecule CD28 (CD4⁺CD28null) than CMV-seronegative patients. Increased numbers of CD28null T cells associates with epoetin nonresponsiveness in patients with ESRD, but whether expansion of CD4+CD28null T cells in CMV-seropositive patients associates with demand for epoetin is unknown. In a cohort of 129 stable patients with ESRD, CMV seropositivity significantly associated with a lower hemoglobin level in predialysis patients (12.5 versus 11.5 g/dl; P < 0.02). CMV seropositivity did not associate with average hemoglobin level in hemodialysis patients, but CMV-seropositive patients required significantly more epoetin (median 12,000 versus 6300 U/wk; P = 0.02). Multivariate linear regression analysis identified CMV seropositivity as the only variable significantly associated with hemoglobin levels in predialysis patients and epoetin dosages in hemodialysis patients. In CMV-seropositive hemodialysis patients, the number of circulating CD4⁺CD28null T cells positively correlated with epoetin dosage. These CD4⁺CD28null T cells were proinflammatory; they were capable of producing large amounts of IFN- and TNF-. In conclusion, expansion of CD4⁺CD28null T cells in CMV-seropositive patients with ESRD associates with increased demand for epoetin.

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673