Hepatic erythropoietin response in cirrhosis

Abstract

Background Erythropoietin (EPO) is produced in the liver during fetal life, but after birth the production shifts to the kidneys. The liver maintains a production capacity of 10% of the total EPO-production, but can be up-regulated to 100%. Previous studies have demonstrated both elevated and reduced concentrations of EPO in cirrhosis. Increased EPO concentrations could be expected due to anemia, hypoxia, renal hypoperfusion, or EPO-mediated hepatoprotective mechanisms. In contrast, poor hepatic production capacity may cause reduced EPO concentrations in cirrhosis. In the present paper we aimed to study hepatic and renal venous concentrations of EPO in relation to the severity of the disease. Materials and methods We included 24 patients with alcoholic cirrhosis and eight age-matched healthy controls. All had a full catheterization performed with the determination of EPO concentrations in the hepatic, renal and femoral veins and artery. All patients were clinically, biochemically, and hemodynamically characterized. Results The median arterial EPO concentrations in the cirrhotic patients and controls were 7.1 mIU/mL (range 3.5–179) and 7.2 mIU/mL (range 3.8–15.3), respectively. In the patient group we found no significant correlations to stage of disease of hemodynamic derangement. Conclusion We found no significant differences in EPO concentrations across the liver, kidney, or peripheral circulation in the patient or control groups; and no significant correlations to clinical, biochemical, or hemodynamic characteristics. This suggests that hepatic EPO synthesis is not enhanced in cirrhosis, but larger scale studies are needed to clarify this question.

Key Words:

• Anemia
• angiogenesis
• cirrhosis
• chronic inflammation
• erythropoietin
• hemodynamic disturbances
• hepatic nephropathy
• hypoxia
• tissue protection
• vasoconstriction
• vasodilation

Disclosure statement

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.