High haematocrit in haemodialysis patients can be controlled by theophylline administration

Three patients on chronic maintenance haemodialysis have progressivelyincreased their haematocrit to reach values between 40 and 45%,a situation associated with an increased risk of thrombosisof their arteriovenous fistulae. Two of them had been submittedto repeated phebotomies, which remained unsuccessful despitethe induction of a profound iron deficiency in one of them.Hence, a trial with oral theophylline was performed in the threepatients, resulting in a sustained decrease of the haematocrit(from 43.6 to 33%) and endogenous erythropoietin (from 46 to15 mU/ml) levels. In two patients, theophylline therapy wasstopped transiently due to gastrointestinal side-effects, whichresulted in a rapid return to previous haematocrit levels; rechallengewith a better tolerated preparation, however, was efficientagain. We conclude that oral theophylline appears to be an efficienttreatment to control too high haematocrit levels in dialysispatients.