erythropoietin (EPO, Harvest Moon)

Trial of erythropoietin and platelet rich plasma as adjunctive treatment in dogs with paraplegia and absent pan perception after thoracolumbar intervertebral disc extrusion and surgical decompression: A clinical pilot study.

Janzen Madison M, Faissler Dominik D, Rozanski Elizabeth E, Kowaleski Michael P MP

To assess the effectiveness of adjunctive treatment with either systemic erythropoietin or local platelet rich plasma administered at the time of decompressive surgery in dogs with severe spinal cord injury (SCI). Prospective randomized study. A total of 32 client owned dogs presented for acute onset of paraplegia and loss of pain perception after a thoracolumbar disc extrusion. All dogs underwent a standard laminectomy within 24 h after admission and were randomly assigned to one of the following treatment groups: (1) Subarachnoid saline (controls), (2) subarachnoid autologous platelet rich plasma (PRP), or (3) subarachnoid saline plus IV erythropoietin (EPO). Examinations were performed initially at the time of admission, and 1, 3, 7-, 14-, 42-, and 84-days post-surgery. Parameters of interest included return of pain perception, motor or ambulatory function, and fecal or urinary continence. Statistical analysis was performed with SPSS for Windows 30 software with p < .05. The median age of the 32 dogs enrolled was 5 years (3-12.5 years). Dachshunds were the most common breed. One dog (3.1%) developed myelomalacia 4 days post-surgery and was euthanized. Three months post-surgery, 24/32 (75%) dogs regained ambulatory function whereas 7/32 (21.8%) did not. There was no overall difference among groups. Dogs treated with EPO appeared to have a trend towards a reduction in incontinence (Fisher exact test, p = .089) but a larger study is needed to verify this apparent finding. The use of EPO might be beneficial to reduce the likelihood of incontinence, but the low number of patients prohibits definitive conclusions. There was no statistically significant clinical benefit found associated with local application of PRP and systemic injection of EPO at the time of decompressive surgery.

Associations between erythropoietin resistance and iron metabolism markers in patients undergoing extended-hours and conventional hemodialysis.

Yamada Takumi T, Nishibori Nobuhiro N, Okazaki Masaki M, Hishida Manabu M et al.

Extended-hours hemodialysis, defined as ≥6 h/session, three or four times per week, has been associated with lower erythropoietin resistance index (ERI), although the biological mechanisms remain unclear. We aimed to compare the associations between ERI and iron metabolism markers in patients undergoing extended-hours versus conventional hemodialysis. We included patients who received either extended-hours or conventional hemodialysis between January and March 2020. The ERI was calculated by dividing the weekly erythropoiesis-stimulating agent (ESA) dose, expressed as epoetin equivalents divided by body weight and hemoglobin level. Linear and non-linear associations were evaluated using multivariable linear regression and restricted cubic spline (RCS) analyses. We analyzed 366 patients (178 receiving extended-hours hemodialysis and 188 receiving conventional hemodialysis). Hemoglobin levels were 10.9 and 11.2 g/dL, median ferritin levels were 34.8 and 63.6 ng/mL, and median transferrin saturation (TSAT) values were 16.9% and 20.5%, respectively. Extended-hours hemodialysis was associated with a lower ERI after multivariable adjustment (coefficient, -4.49 IU/kg/week per g/dL; 95% confidence interval, -6.76 to -2.22). In the RCS analysis, ERI increased with decreasing ferritin levels in the conventional hemodialysis group, whereas no increase was observed at lower ferritin levels in the extended-hours group. A similar trend was observed with respect to TSAT. Extended-hours hemodialysis was associated with lower ERI. Exploratory RCS analyses suggested potential modality-related differences in the relationships between ERI and ferritin or TSAT. These findings suggest that the association between iron status and ESA responsiveness may differ by dialysis modality and warrants further investigation.

Renal contractile pericytes: When vascular cells choose erythropoietin over renin.

Empitu Maulana A MA, Yasin Muhammad Nabhan MN, Saputra Ketut Wahyu A KWA, Lesmana Jevon Aaron JA

SGLT2 Inhibitors: Dual Effects on Erythropoiesis and Bone Metabolism.

Mohammad Aseel H AH, Mohammad Shatha H SH, Alsaaty Mohammad H MH

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been used as a therapy for type 2 diabetes mellitus, heart failure, and chronic kidney disease (CKD); however, their effects on erythropoiesis, phosphate regulation, and bone turnover are incompletely clarified. Studies report a marked increase in hemoglobin and hematocrit during treatment, suggesting an erythropoietic response rather than simple hemoconcentration. Simultaneously, changes in mineral metabolism, including a modest increase in phosphate, fibroblast growth factor-23 (FGF-23), and parathyroid hormone (PTH), raise questions about the possible consequences for bone quality, mainly in individuals with diabetes or CKD who are at increased risk of fracture. Accordingly, this narrative review was structured through a literature search of PubMed, Scopus and Google Scholar for studies published in English up to November 2025. Keywords included SGLT2 inhibitors, erythropoiesis, bone metabolism, phosphate homeostasis, FGF-23, PTH, vitamin D, bone mineral density (BMD) and fracture. Randomized trials, mechanistic studies, animal experiments, observational cohorts, sub-analysis and reviews were included. Current evidence shows that SGLT2 inhibition promotes erythropoietin production, enhances iron mobilization and modifies the bone marrow environment, while also influencing the FGF- 23-PTH-vitamin D axis through renal phosphate handling. Although canagliflozin has been associated with reduction in hip BMD and possible fracture risk, findings from the drug class remain inconsistent and are often confounded by baseline comorbidities. In conclusion, SGLT2 inhibitors trigger a connected hematologic and mineral changes, but their long-term skeletal impact remains uncertain. Further mechanistic and longitudinal studies are advised to clarify these outcomes.