Normalization of hematocrit in hemodialysis patients with cardiac disease does not increase blood pressure

Since the earliest reports of the use of Epoetin alfa in hemodialysis patie nts, it has been described that Epoetin alfa may exacerbate preexisting hyp ertension or induce hypertension in End Stage Renal Disease (ESRD) patients not previously hypertensive. We undertook this study to determine if the c orrection of anemia in ESRD patients with cardiac disease from a hematocrit of 30 +/- 3% to 42 +/- 3% with the use of Epoetin alfa would result in inc reased blood pressure. This study was a substudy of the "Normal hematocrit Study". Methods: Thirty-one patients were randomized into one of two arms. Patients in Group A had their hematocrit increased with the use of slowly escalatin g doses of Epoetin alfa to 42 +/- 3% and patients in Group B were maintaine d with a hematocrit of 30 +/- 3% throughout the course of the study. All pa tients had their blood pressure recorded with a 24 hour ambulatory BP devic e at study entry and at 28 weeks following randomization when they had achi eved their target hematocrit. Pre-dialysis systolic and diastolic BP was al so recorded. Results: The mean hematocrit increased in Group A from 29.1 +/- 2.4% Is 40. 8 +/- 5.2% after 30 weeks. The hematocrit in Group B remained stable at 30 +/- 3% throughout the course of the study. There was no difference in mean daytime, mean nighttime or 24 hour systolic or diastolic blood pressure bet ween Groups A and B at either baseline or follow-up. Neither was there a di fference in mean pre-dialysis systolic or diastolic BP between Groups A or B at baseline or Follow-up. Four patients in Group A and 4 patients in Grou p B required an increase in their antihypertensive medication during the co urse of the study. Conclusion: It is possible to increase hematocrit to normal levels in hemod ialysis with the administration of Epoetin alfa. The increase in hematocrit from 30 +/- 3% to 42 +/- 3% is not associated with increased blood pressur e.