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    Serum-soluble Fas and serum levels of erythropoietin in chronic kidney disease
    (Dustri-verlag Dr Karl Feistle, 2010-01-01) Goes, M. A. [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Manfredi, Silvia Regina [UNIFESP]; Cendoroglo, Miguel [UNIFESP]; Batista, Marcelo Costa [UNIFESP]; Canziani, Maria Eugênia Fernandes [UNIFESP]; Balakrishnan, V. S.; Pereira, B. J. G.; Draibe, Sergio Antonio [UNIFESP]; Cendoroglo, Maysa Seabra [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Tufts Univ New England Med Ctr
    Background: Soluble Fas levels (sFas) are increased in the serum of uremic patients and are associated with the presence of anemia and recombinant human EPO (rHuEPO) dosage in dialysis patients. It is possible that sFas levels are associated with all increased need for serum erythropoietin levels (Epo) in chronic kidney disease and dialysis patients ill order to maintain hematocrit (Hct) levels. Aims: To investigate the relationship between serum sFas levels, serum Epo levels and the ratio between Epo levels and Hct ill uremic patients. Methods: We studied 52 predialysis chronic kidney disease patients (CKD; 33 M, 57 +/- 12 years, hematocrit (Hct) = 37 +/- 7%), 29 peritoneal dialysis patients (PD; 12 M, 54 +/- 14 years, Hct = 36 +/- 7%), 29 hemodialysis patients (HD; 19 M, 47 +/- 14 years, Hct = 33 +/- 5%) and 29 healthy volunteers (control group 17 M, 50 +/- 16 years, Hct = 43 +/- 3%). We examined the relationship between Hct and serum levels of Epo, sFas, C-reactive protein, IL-6 and iron status. The ratio of serum Epo divided by Hct (Epo/Hct) was used as an indicator of Epo responsiveness. Results: Compared to normal subjects, the CKD, PD and HD groups presented lower Hct levels and higher serum levels of sFas, Epo, Epo/Hct and IL-6. serum levels of sFas correlated negatively with albumin (r = -0.24, p = 0.02), IL-6 (r = -0.18, p = 0.04) and Epo/Hct (r = -0.37, p < 0.001). In multivariate analysis, after adjusting for markers of iron store and inflammation, only sFas correlated with Epo/Hct. In the CKD group, there were negative correlations between serum levels of sFas and glomerular filtration rate (GFR) (r = -0.45, p < 0.001) and between Epo/Hct and GFR (r = -0.32; p = 0.02). There was a positive correlation between Epo/Hct and serum levels of sFas in the CKD group (r = 0.31, p = 0.03) and in the HD groups (r = 0.58, p = 0.001). Conclusion: Our findings show that serum sFas is associated with higher Epo/Hct ratio, suggesting that sFas may be a marker of Epo hyporesponsiveness ill uremia. Further studies are needed to deter-mine whether sFas is just a marker of Epo hyporesponsiveness or is also involved in its pathophysiology.