TREATMENT OF RENAL ANEMIA BY ERYTHROPOIETIN SUBSTITUTION - THE EFFECTS ON THE CARDIOVASCULAR-SYSTEM

Recombinant human erythropoietin (r-HuEPO) effectively corrects the an emia of end stage renal disease (ESRD). Development or aggravation of hypertension has been the most commonly reported side-effect of r-HuEP O treatment. Placebo controlled trials have shown incidence rates rang ing from 16 - 21%. Renal failure itself obviously is a prerequisite in the pathogenesis of r-HuEPO-induced hypertension, since it was never observed in anemic patients without renal disease. Increased whole blo od viscosity and/or reduced hypoxic vasodilatation due to the rise in hematocrit may play a role in the development of hypertension at high concentrations of hematocrit. However, at hematocrit levels around 30% additional hypertensinogenic effects of r-HuEPO treatment seem likely . Endothelin and prostanoids are possible mediators of this effect. Le ft ventricular hypertrophy (concentric and eccentric), which can be du e to hypertension and anemia, is commonly observed in ESRD patients an d has been shown to be a predictor of cardiac morbidity and mortality in these patients. Following correction of anemia with r-HuEPO measure s of left ventricular hypertrophy decrease by about 18% within a year. Normalization, though, is generally not achieved and in patients with r-HuEPO induced hypertension the increase of blood pressure may oppos e the beneficial effects of r-HuEPO treatment on cardiac hypertrophy.