SHORT-TERM CORRECTION OF ANEMIA WITH RECOMBINANT-HUMAN-ERYTHROPOIETINAND REDUCTION OF CARDIAC-OUTPUT IN END-STAGE RENAL-FAILURE

Children with end stage renal failure and anaemia have an increased ca rdiac index and often gross ventricular hypertrophy. The contribution of anaemia to these abnormalities is uncertain. Eleven children with e nd stage renal failure and anaemia (haemoglobin concentration <90 g/l) were enrolled into a single blind, placebo controlled, crossover stud y to assess the cardiovascular effects of reversing anaemia using subc utaneous human recombinant erythropoietin (r-HuEpo). Each limb lasted 24 weeks; seven children completed both limbs of the study. Haemoglobi n increased with r-HuEpo, remaining above 100 g/l for a mean of 11 wee ks. Cardiac index fell as a result of a reduction in both left ventric ular stroke volume and heart rate. Left ventricular end diastolic diam eter also decreased. In five children left ventricular wall thickness and left ventricular mass decreased with r-HuEpo, but this failed to r each significance for the whole group. Blood pressure did not change i n six normotensive children completing an r-HuEpo limb; the decrease i n cardiac index was therefore balanced by an increase in peripheral va scular resistance. Three children were taking antihypertensive treatme nt at the start of the study; one required an increase, and one a decr ease, in treatment during the r-HuEpo limb. Short term treatment with r-HuEpo reduces cardiac index. A longer study is needed to determine w hether this will, in time, result in a significant reduction in left v entricular hypertrophy.