Introduction. Experimental studies, supporting a protective role of erythropoietin on vascular disease, has not been sustained by three clinical trials performed in advanced chronic kidney disease patients showing that the target of normal haemoglobin levels does not improve chronic renal disease and overall morbidity. It is probable that low, earlier doses of erythropoiesis stimulating agents may be much more effective to improve outcome of chronic kidney patients than high, later doses.

Aims. and method. A large, multicenter, retrospective study was performed in 4 Lombardy Renal Units to evaluate anemia status of dialysis patients with particular attention to the hemoglobin target, erythropoiesis stimulating agents doses, amount of iron supplementation and dialysis efficiency. Moreover, we carried out a subgroup analysis of vitamin B replete patients to evaluate a supposed relationship between high homocysteine levels, low methylation potential and low hemoglobin levels.

Results. 446 patients, 254 males and 152 females, participated to the study. Mean age was 68 years. All centers reached the mean hemoglobin target (11,4 g/dl). Patients with high urea kt/V (mean value of 1,48) and with subcutaneous administration of erythropoietin had a lower consumption of erythropoietin than patients with normal urea kt/V (mean value of 1,13) and with intravenous administration of erythropoietin, respectively 6742 vs. 11394 IU/week (p< 0,01) and 6397 vs. 10613 IU/week (p< 0,01). Patients with high mean homocysteine values (34,8 micromoles/l) had a lower consumption of erythropoietin than patients with normal homocysteine level (15,1 micromoles/l), respectively 6845 vs. 8811 IU/week (p = 0,09), and similar hemoglobin levels (11,3 ± 0,1 vs. 11,2 ± 0,1; p: ns).

Conclusions. Erythropoietin subcutaneous administration and high dialysis efficiency were associated with lowered erythropoiesis stimulating agents doses. B vitamin replete patients with severe hyperhomocysteinemia had a trend towards a lower erythropoietin consumption than vitamin B treated patients with normal or slightly increased homocysteine values, in contrast to the hypothesis of a direct relationship between methylation potential and red blood cells production.