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Nephrogenic Fibrosing Dermopathy and High-Dose Erythropoietin Therapy
- Sundararaman Swaminathan, MBBS;
- Iftikhar Ahmed, MD;
- James T. McCarthy, MD;
- Robert C. Albright, DO;
- Mark R. Pittelkow, MD;
- Noel M. Caplice, MD, PhD;
- Matthew D. Griffin, MB BCh; and
- Nelson Leung, MD
- From Mayo Clinic College of Medicine, Rochester, MN 55905.
Background: Nephrogenic fibrosing dermopathy is a newly described cutaneous disorder characterized by mucin deposition and dermal infiltration of CD34+ spindle cells in patients with renal insufficiency (1). No etiologic factor besides kidney disease has been linked to this disorder, although CD34 is a marker of hematopoietic progenitor cells. Erythropoietin is the principal therapy for anemia in both dialysis and predialysis patients. Its use dramatically increased after the publication of the Dialysis Outcomes Quality Initiative guidelines for anemia management in 1997 (2). Of interest, this is the same year that the first case of nephrogenic fibrosing dermopathy was reported (3).
Objective: To investigate the possible association between erythropoietin and nephrogenic fibrosing dermopathy.
Methods and Findings: Data on clinical, laboratory, and erythropoietin variables (dose, date of initiation, and dose escalation >25%) were collected for 22 consecutive biopsy-proven cases of nephrogenic fibrosing dermopathy. Data on 50 consecutive patients from our center who were receiving long-term hemodialysis were collected for comparison. Univariate analysis was performed by using the Pearson chi-square test and analysis of …
