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February 09, 2010

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somerville

A converse issue worth exploring is whether men are being systematically undertreated with EPO, given that normal male hemoglobin ranges from 14 to 17.5 g/dL, while premenopausal women have a range of between 12 and 16 g/dL, and yet both groups are held to the same target hemoglobin while on dialysis. This practice incorrectly assumes that males cease to be different just because they are on dialysis, which is of course false. Nephrologists routinely break their wrists patting themselves on the back for keeping male dialysis patients at a hemoglobin of 11.5, as though male patients could feel well while struggling at 2/3 of the hemoglobin level nature had designed some of them to have.

Another issue which nephrologists always ignore to make their lives simpler is the fact that the 40% of renal patients who are diabetic suffer a worsening of diabetic complications from anemia. See J. McGill and D. Bell, "Anemia and the Role of Erythropoietin in Dialysis," Journal of Diabetic Complications, vol. 20, no. 4, p. 262 (2006) No account is taken of this problem in managing the risks and benefits of EPO dosing in diabetics.

Bill Peckham

A related issue would be the effect of altitude on hemoglobin levels. Denver is famously a mile high; there are communities 1,000s of feet higher.


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