The cardiovascular effects of r-HuEPO in end-stage renal disease

R. N. Foley

Research output: Contribution to journalReview articlepeer-review

Abstract

Anaemia is common in patients with end-stage renal disease (ESRD) and leads to tissue hypoxia and compensatory vasodilatation. This vasodilatation leads to increased venous return and contributes to both left ventricular hypertrophy (LVH) and left ventricular dilatation (LVD). These latter abnormalities are common in patients with ESRD but are maladaptive and are predictive of subsequent mortality, independently of age, diabetes and clinically apparent cardiovascular disease. Recent data suggest that sustained anaemia is independently associated with mortality; however, the target haematocrit (Hct) that minimises the risk of mortality in peritoneal dialysis and haemodialysis patients is unknown. Anaemia is strongly associated with the development of congestive heart failure, a condition associated with a high rate of mortality in ESRD patients. Partial correction of anaemia with recombinant human erythropoietin (r-HuEPO) has been associated with correction of hypoxic vasodilatation and partial regression of LVD and LVH, but at the expense of exacerbation of hypertension, potential arteriovenous graft thrombosis and, possibly, of native arteriovenous fistula loss. To date, it has not been established whether partial correction of anaemia with r-HuEPO decreases the incidence of cardiac disease or improves patient survival. The benefits and risks of complete normalisation of Hct, a matter of considerable current interest, are presently unknown.

Original languageEnglish (US)
Pages (from-to)3-7
Number of pages5
JournalErythropoiesis: New Dimensions in the Treatment of Anaemia
Volume6
Issue number1
StatePublished - 1995

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