Erythropoietin in the General Population: Reference Ranges and Clinical, Biochemical and Genetic Correlates

Niels Grote Beverborg, Niek Verweij, IJsbrand T. Klip, Haye H. van der Wal, Adriaan A. Voors, Dirk J. van Veldhuisen, Ron T. Gansevoort, Stephan J. L. Bakker, Pim van der Harst, Peter van der Meer*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background

Although erythropoietin has been used for decades in the treatment of anemia, data regarding endogenous levels in the general population are scarce. Therefore, we determined erythropoietin reference ranges and its clinical, biochemical and genetic associations in the general population.

Methods

We used data from 6,777 subjects enrolled in the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) study. Fasting venous blood samples were obtained in the morning from all participants from 2001-2003. Serum erythropoietin concentrations were measured using a fully automated chemiluminescent enzyme-labeled immunometric assay. A genome-wide association study was performed to identify genetic determinants.

Results

Mean age (+/- SD) was 53 +/- 12 years and 50% were female. Median (IQR) erythropoietin concentrations were 7.6 (5.8-9.9) IU/L in men and 7.9 (6.0-10.6) IU/L in women. A strong positive correlation was found between erythropoietin and waist circumference, glucose and systolic blood pressure (all P <0.05). In subjects with normal renal function there was a strong exponential relation between hemoglobin and erythropoietin, whereas in renal impairment (eGFR <60 mL/min/1.73m(2)) this relation was linear (men) or absent (women) (P <0.001 for interaction). Single-nucleotide polymorphisms at the HBS1L-MYB locus were shown to be related to erythropoietin levels (P <9x10(-21)), more significantly than other erythrocyte parameters.

Conclusion

We provide age-specific reference ranges for endogenous serum erythropoietin. Erythropoietin levels are positively associated with the components of the metabolic syndrome, except cholesterol. We show that even mild renal failure blunts erythropoietin production and propose the HBS1L-MYB locus as a regulator of erythropoietin.

Original languageEnglish
Article numbere0125215
Number of pages14
JournalPLoS ONE
Volume10
Issue number4
DOIs
Publication statusPublished - 27-Apr-2015

Keywords

  • GLOMERULAR-FILTRATION-RATE
  • CHRONIC KIDNEY-DISEASE
  • CHRONIC-RENAL-FAILURE
  • SERUM ERYTHROPOIETIN
  • TRANSFERRIN RECEPTOR
  • HEART-FAILURE
  • ARTERIAL-HYPERTENSION
  • PLASMA ERYTHROPOIETIN
  • STIMULATING AGENTS
  • DARBEPOETIN ALPHA

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