ERYTHROPOIETIN AND CARDIOVASCULAR RISK

We studied the changes in some cardiovascular risk (CVR) factors in 24 maintenance hemodialysis patients treated for 1 year with recombinant human erythropoietin (rHuEPO) either intravenously (12 cases) or subc utaneously (12 cases). In order to clarify whether changes in some par ameters were due to direct action of rHuEPO or to changes in food inta ke, we divided the patients into two groups: group A was formed by 14 patients who showed an increase in their food intake during rHuEPO the rapy and group B by 10 patients without or with slight changes in thei r food intake. rHuEPO induced an improvement in well-being in 20 of 24 patients and in physical working capacity in 14 of 24, an increase in mean blood pressure in all patients, and hypertension in 4 of 24 pati ents. The incidence of hypertension was slightly higher after intraven ous (3/12) than after subcutaneous (1/12) treatment. The rate of dialy sis treatment with symptomatic hypertension significantly decreased fr om 44.0 +/- 8.0 to 12.1 +/- 2.2% after intravenous and from 41.3 +/- 6 .8 to 10.0 +/- 3.8% after subcutaneous treatment. Evaluation of glucos e metabolism (intravenous glucose tolerance test) before and after 3 m onths of rHuEPO therapy showed an improvement in glucose utilization ( insulin resistance reduction). Cholesterol (CH), low-density lipoprote in CH, triglycerides, and apolipoprotein B significantly increased in group A, but not in group B. Both in groups A and B, high-density lipo protein CH significantly decreased during the first 6 months and retur ned to basal values during the following months, and the apolipoprotei n Al level significantly decreased during the first 4 months and incre ased to levels higher than basal values during the following months. C hanges in CH and apolipoprotein B were also positively correlated with changes in the protein catabolic rate. We infer that rHuEPO has oppos ite effects on CVR, but subcutaneous administration, dietary control, and antihypertensive treatment may produce a net decrease in CVR of ma intenance hemodialysis patients on rHuEPO therapy.