Wakeen MJ, Zimmerman SW
Peripheral vascular disease in diabetic patients on PD
receiving EPO
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S70 1997
It has been suggested that diabetics with peripheral vascular disease
(PVD) may suffer increased complications as a result of EPO therapy due
to alterations in blood viscosity and rheology. This abstract outlines
a retrospective look at 85 diabetic patients on PD of which 55 were on
EPO. Vascular events (including amputations, vascular surgery, or
"severe disease") and hospitalizations were recorded from 1990-1996.
There was a statistically and clinically significant difference in the
number of days in the hospital for "vascular" reasons (2.1 days non-EPO
vs. 14 days EPO) as well as vascular events per patient (0.333 non-EPO
vs. 0.855 EPO treated). Furthermore, the number of months to a major
vascular even (starting point not defined) was 49.8 in the non-EPO group
and only 13.6 months in the EPO treated group. The incidence of leg
amputation/1000 patient months appeared dramatically different (2 in
non-EPO vs. 23 in EPO treated) but did not reach statistical
significance.
Comment: These differences suggest a dramatic worsening of PVD in
diabetic patients treated with EPO. However, until we can define
whether the subset of patients with ESRD and diabetes who do NOT need
EPO represent a "protected" minority causality cannot be established by
such a retrospective study. A prospective, randomized trial (unlikely
in the US) could shed some light on this disturbing issue.
(Sri Narsipur, MD, SUNY-HSC at Syracuse, NY)
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17th Annual CAPD Conference
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