ERYTHROPOIETIN TREATMENT DECREASES CARDIOVASCULAR MORBIDITY AND MORTALITY IN CAPD PATIENTS

Objective: To analyze the effects of recombinant human erythropoietin (rHuEPO) therapy on cardiovascular (CV) morbidity and mortality among continuous ambulatory peritoneal dialysis (CAPD) patients. Design: Ret rospective comparative study. Setting: CARD unit in a university hospi tal. Patients: Forty-two patients on rHuEPO treatment for at least one year were compared with an rHuEPO nonuser group of 113 patients. Subc utaneous rHuEPO doses were adjusted to a hemoglobin objective level of 10.5 - 13.5 g/ dL. Fifty-seven patients were considered as high cardi ovascular risk (HCVR), 17 in the rHuEPO group and 40 in the rHuEPO non user group. Ninety-eight patients were classified as low cardiovascula r risk (LCVR), 25 of whom were in the rHuEPO group. Results:The incide nce of cardiovascular morbidity was more frequent in the rHuEPO nonuse r than in the rHuEPO user group (40% vs 22%) and in HCVR than in LCVR patients (59.6% vs 20.4%). By multiple logistic regression analysis, t he best model to explain the development of cardiovascular morbidity c omprises rHuEPO treatment, CV risk, and age. In the rHuEPO user group, HCVR and LCVR patients did not show significant differences in surviv al, while in the rHuEPO nonuser group, HCVR patients had a lower survi val rate than LCVR patients (p = 0.0003). Cox proportional hazards mod el revealed that LCVR patients had an excellent prognosis compared wit h HCVR patients in the rHuEPO nonuser group, but this difference disap peared in the rHuEPO user group. Conclusion: These data show a benefic ial effect of rHuEPO treatment on cardiovascular morbidity and mortali ty in CARD patients, evidenced by the elimination of the correlation b etween prior cardiovascular risk and subsequent mortality.