This is a retrospective study of 30 male haemodialysis patients who had been receiving recombinant human erythropoietin (rHuEPO) for at least six months. It set out to answer the question: "Is the occurrence of vascular-access thrombosis and hospitalisation among chronic haemodialysis patients higher in those with haematocrits (Hcts) greater than 36%, compared with those with Hcts <36%?"

This is an American study, so there is a greater emphasis on synthetic grafts of polytetrafluoroethylene (PTFE): 40% of patients had synthetic grafts and 60% arterio-venous fistula (AVF). This access-choice ratio is different from that commonly seen in the UK and should be taken into consideration when reading this paper.

The article provides a very brief introduction on the benefits of rHuEPO. It includes a review of the literature discussing the continuing debate about whether or not rHuEPO is associated with increased vascular-access thrombosis, and the authors examine the links between access thrombosis and Hct levels.

However, this information is primarily concerned with grafts and it is not that easy to identify whether or not the authors support the links between Hct and access thrombosis. In addition, other causes of access thrombosis are discussed in minimal detail.

The conclusion from their data suggests that Hcts >36% are not associated with increased thrombosis but are associated with lower hospitalisations. However, the data presented has no statistical significance, owing to the large number of limitations that the authors themselves recognise.

Nevertheless, as the authors suggest, this article will probably be useful in inspiring further research in this area with a larger and more comprehensive sample group. In addition, a number of the references referred to would provide further and more detailed information on the causes of access thrombosis and the effects of rHuEPO.

I would recommend this article if you have an interest in vascular access, as it will provide you with further reading. However, the study itself has many limitations and more research is needed to answer the question it poses.

Lynn Fullerton