HDCN Article Review/Hyperlink

Vaziri ND, Oveisi F, Reyes GA, Zhou XJ

Dysregulation of melatonin metabolism in chronic renal insufficiency: Role of erythropoietin induced anemia

Kidney Int (Aug) 50:653-656 1996

Many dialysis patients suffer from serious sleep disorders such as sleep apnea syndrome, and many more simply have trouble sleeping. At every drugstore counter in the United States one can find melatonin being sold as a sleep aid. So one wonders why no one has studied melatonin regulation in dialysis patients, and why no one has tried to give melatonin to dialysis patients to see if it helps them sleep safely.

The study by Vaziri is a start, although it was done in rats, not people. Rats with chronic renal failure (5/6 nephrectomy) and associated anemia were found to have marked attenuation of the normal nocturnal surge in serum melatonin concentration. Also, the pineal gland melatonin concentration was significantly depressed. Bright light did, however, suppress melatonin production as it did in control animals. Interestingly, correction of the anemia per se using EPO resulted in marked improvement in the nocturnal increase in serum melatonin levels.

Comment: As a rule, we don't review rat studies for HDCN, as the clinical implications of such studies are often dubious. This is certainly the case for the present study. We are only reviewing it in the hopes that someone will do some more definitive studies of melatonin physiology in humans with ESRD. These results certainly do not support the use of melatonin in patients with ESRD, but simply suggest an interesting area of future research. (John T. Daugirdas, M.D., University of Illinois at Chicago)