Even though this article may not directly apply to a patient under dialysis or some one younger, the take away lesson could be that regardless of hemoglobin levels, there are mortality risks associated with high erythropoietin levels. It may be prudent to give lower dosages of EPO (synthetic erythropoietin) to the elderly and to infuse the EPO in a slower uptake manner such as subcutaneous injection as opposed to IV perfusion.
"Among people aged 85 years and older, elevated erythropoietin levels were associated with an increased risk of death, independent of hemoglobin levels."
http://www.cmaj.ca/cgi/content/abstract/182/18/1953Effect of erythropoietin levels on mortality in old age: the Leiden 85-plus Study
Wendy P.J. den Elzen, MSc, Jorien M. Willems, MD, Rudi G.J. Westendorp, MD PhD, Anton J.M. de Craen, PhD, Gerard Jan Blauw, MD PhD, Luigi Ferrucci, MD PhD, Willem J.J. Assendelft, MD PhD and Jacobijn Gussekloo, MD PhD
Background: The production of erythropoietin is triggered by impaired oxygen delivery to the kidney, either because of anemia or hypoxemia. High erythropoietin levels have been shown to predict the risk of death among patients with chronic heart failure. We investigated the prognostic value of elevated erythropoietin levels on mortality among very elderly people in the general population.
Methods: The Leiden 85-plus Study is a population-based prospective follow-up study involving 599 people aged 85 years in Leiden, the Netherlands, enrolled between Sep- tember 1997 and September 1999. Erythropoietin levels were determined at age 86. For this analysis, we includ ed 428 participants with a creatinine clearance of at least 30 mL/min. Mortality data, recorded until Feb. 1, 2008, were obtained from the municipal registry.
Results: During follow-up, 324 (75.7%) participants died. Compared with participants whose erythropoietin levels were in the lowest tertile (reference group), those whose levels were in the middle tertile had a 25% increased risk of death (hazard ratio
1.25, 95% confidence interval [CI] 0.95– 1.64), and those whose levels were in the highest tertile had a 73% increased risk (HR 1.73, 95% CI 1.32–2.26) (p value for trend < 0.01). The association between erythropoietin levels and mortality remained largely unchanged after we adjusted for sex, creatinine clearance, hemoglobin level, comorbidity, smoking status and C- reactive protein level, and was similar for deaths from cardiovascular and noncardiovascular causes.
Interpretation: Among people aged 85 years and older, elevat ed erythropoietin levels were associated with an increased risk of death, independent of hemoglobin levels.
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