Growth characteristics of circulating hematopoietic progenitors in terminal renal failure.

Background: In patients with terminal renal failure, the most frequently noted hematological change is normocytic normochromic anemia. As not all anemic patients respond in the same way to treatment with human erythropoietin, the aim of our investigation was to confirm the hypothesis that the origin of this anemia is multifactorial.

Material/methods: Therefore we cultivated peripheral blood CFU GEMM, CFU GM, and BFU E in 65 patients treated by hemodialysis, subdivided in two groups according to creatinine concentration (Group 1: <900 micromol/l, Group 2: >900 micromol/l). Hematopoietic stem cells were cultivated on methylcellulose with growth factors added.

Results: Growth inhibition of BFU E and CFU GM and a negative correlation between CFU GEMM, CFU GM, and BFU E growth and urea concentration were found in the entire group of patients. CFU GEMM growth in Group 2 was inhibited. Positive correlation between CFU GM and BFU E, CFU GEMM and BFU E, and CFU GM and CFU GEMM growth was established. In Group 1 a negative correlation between BFU E and CFU GM growth and creatinine concentration was found, and in Group 2 a negative correlation between BFU E and CFU GM growth and urea concentration.

Conclusions: Relatively decreased erythropoietin concentration is one of the major causes of renal anemia. As CFU GM and CFU GEMM growth was decreased, hematopoiesis must be disturbed at a higher level and is affected by other factors connected with uremia, such as the lack of T(4) lymphocytes and the dialysis procedure.