six on CAPD and 20 patients with transplanted kidneys. We still have about 130 ... Corazza F, Bergmann P, Dratwa M, Guns M, Fondu P. Responsiveness to ...
Nephrol Dial Transplant (1993) 8: 568-575
Nephrology Dialysis Transplantation
Letters Dialysis in Bosnia and Herzegovina Sir, It is already 12 months since war and blockades of our Bosnian towns began. Communications with Western Europe are extremely difficult. However, as a doctor of medicine, I have a duty to inform you about conditions for my patients. Before the aggression on Bosnia and Herzegovina started, in the Nephrology and Dialysis Department of Internal Ginic Tuzla, we had about 150 patients on chronic haemodialysis, six on CAPD and 20 patients with transplanted kidneys. We still have about 130 patients on regular therapy. Since the war has started 20 patients have died. At the moment we do not have any patients on CAPD. About 30 patients have escaped to Croatia or Western Europe but we have accepted the same number of refugees, patients from the occupied regions of Bosnia. The situation with dialysis is critical. At the moment we have reserves for only 30 days. Thanks to the chemical industry which is situated in Tuzla, we are able to produce solutions for haemodialysis ourselves because there are conditions and means for that kind of production in our town. We are aware that consumable materials for dialysis are very expensive so we shall be eternally grateful to every organisation or individual who would, in any way, help us to save the lives of our patients. Our minimal needs per month are about 1200 dialysers including systems and needles and we should be grateful to receive any donation of such equipment. If you are able to help please send your donated material to me at the address given below. Your help will be greatly appreciated by the people of Tuzla and Bosnia Herzegovina. Ass. dr Enisa MeSic University Hospital Tuzla— Internal Clinic Department of Nephrology and Dialysis 75000 Tuzla Bosnia and Herzegovina
Dr Enisa MeSic
Responsiveness to recombinant human erythropoietin Sir, In a recent paper in this journal, F Corazza et al. [1] report their work to discover if response to recombinant human erythropoietin (rHuEpo) is related to a number of biological parameters, including numbers of circulating erythroid progenitor cells, measured prior to treatment. Some features of this interesting and innovative work warrant comment. In the study, patients received either intravenous (i.v.) or subcutaneous (s.c.) rHuEpo in varying doses. However, in the data analysis, the i.v. and s.c. groups were not evaluated separately. The pharmacokinetics of i.v. and s.c. rHuEpo are different, with s.c. rHuEpo eliciting a greater response than the same dose given i.v. [2]. A separate analysis might have been done for each route of administration. Five outcome parameters were defined to assess responsiveness to rHuEpo. Dose is clearly a vital determinant of haemoglobin response [3] and yet only one outcome parameter made allowance for the varying doses used (75, 100,
120, or 150 U/kg/week). The authors acknowledge this, but interpretation of the remaining four parameters is inevitably blurred, and there are further difficulties. The outcome parameter defined as the haemoglobin 1 month after starting treatment does not consider the initial haemoglobin (range 6.2-8.8 g/dl). There is a similar problem with the parameter 'therapeutic cumulative dosage of rHuEpo' defined as the total dose administered to a patient between the beginning of the treatment and the time when the haemoglobin reached the target value (10-12 g/dl). We congratulate the authors on their experimental work, but feel that their analysis of the results makes interpretation of their findings difficult. East Birmingham Hospital, Bordesley Green East, Birmingham B9 5ST, UK
S. P. Gibson P. Cockwell B. H. B. Robinson J. B. Hawkins
1. Corazza F, Bergmann P, Dratwa M, Guns M, Fondu P. Responsiveness to recombinant erythropoietin in end-stage renal disease. An analysis of the predictive value of several biological measurements, including circulating erythroid progenitors. Nephrol Dial Transplant 1992; 7: 311-317 2. Besarab A, Vlasses P, Caro J et al. Subcutaneous administration of recombinant human erythropoietin for treatment of ESRD anemia. (Abstract) Kidney Inl 1990; 37: 236 3. Sobota JT. Recombinant human erythropoietin in patients with anemia due to end-stage renal disease. US Multicenter Trials. Contrib Nephrol 1989; 76: 166-178
Reply by authors We thank Dr Gibson and his colleagues for their comments. The two groups of patients (i.v. and s.c.) have not been statistically evaluated separately because they were too small, but no difference in response parameters could be observed between them, and the good versus poor responders ratio was the same in the two groups (chi-square test). This was mentioned at the end of the 'Results' section. We agree with Dr Gibson on the fact that the interpretation of our results was complicated by the heterogeneity of our population. This is why we explored several response parameters, in particular those that take account of the initial haemoglobin and the starting erythropoietin dosage (HB/A). Moreover, as mentioned in the Discussion, the significant correlation observed between this last parameter and the BFU-E number was confirmed using a partial rank-order correlation test performed between Hb and BFU-E number for a starting dosage maintained constant. It is well known that clinical studies involve unavoidable requirements that may render interpretation difficult. However, we thought that the significant correlations observed in this study were encouraging in the investigation of the regulatory mechanisms of erythropoiesis in end-stage renal disease. Laboratory of Haematology, Brugmann Hospital, Brussels, Belgium
© 1993 European Dialysis and Transplant Association-European Renal Association
F. Corazza P. Fondu
