Effects of normal hematocrit on ambulatory blood pressure in epoetin-treated hemodialysis patients with cardiac disease

Background. Hypertension is a recognized complication of partial correction of anemia with recombinant human erythropoietin (epoetin) in hemodialysis patients. We used interdialytic ambulatory blood pressure (ABP) monitoring to study the effects of partially corrected anemia versus normal hematocrit (hct) on BP in hemodialysis patients. Methods. Repeated interdialytic ABP monitoring was performed for up to one year in 28 chronic hemodialysis patients with cardiac disease who were rand omized to achieve and maintain normal hct levels (42 +/- 3%, group A) or an emic hct levels (30 +/- 3%, group B) with epoetin. Routine BP measurements obtained at dialysis treatments were also evaluated. Results. Mean hct levels were 30.7 +/- 0.7% in group A and 30.6 +/- 0.7% in group B at baseline, then 39.3 +/- 1.2% (group A) and 33.5 +/- 0.6% (group B) at four months, and 42.0 +/- 1.1% (group A) and 30.4 +/- 1.0% (group B) at 12 months. Baseline ABP and routine dialysis unit BP levels were not di fferent between the groups. At 2, 4, 8, and 12 months of follow-up. there w ere no statistically significant differences in any BP parameters between g roups or increases in any BP parameters in either group A or group B patien ts compared with baseline. At 12 months, the mean nighttime diastolic BP (D BP) in group A patients was slightly but significantly lower than the mean daytime DBP (daytime DBP 76.6 +/- 1.9 mm Hg vs, nighttime DBP 72.9 +/- 2.1 mm Hg. P < 0.05). The mean daytime and nighttime BPs were not different fro m each other at two, four, and eight months in group A or at any time in gr oup B1 and in both groups, most patients had little diurnal change in BP, Conclusion. Correction of her to normal with epoetin in chronic hemodialysi s patients with cardiac disease did not cause increased BP as assessed by i nterdialytic ABP monitoring or by the measurement of routine predialysis ac id postdialysis BP. There was little diurnal change in systolic or diastoli c BP at baseline or after correction of anemia to normal levels, and althou gh mean nighttime DBP was lower than mean daytime DBP at 12 months in group A, the maintenance of normal hct levels did not affect the abnormal diurna l BP pattern seen at moderately anemic her levels in most patients.