Cardiovascular Effects of Increasing Hemoglobin in Chronic Renal Failure

Abstract

Partial correction of renal anemia by the use of recombinant human erythropoietin is associated with various effects on cardiovascular performance parameters. A decrease in cardiac output as well as an increase in systemic peripheral resistance have been noted and the pathogenetic basis of these changes will be discussed. Furthermore this article will focus on the potential cardiovascular consequences of prolonged correction of anemia in patients with renal failure. The literature on the clinical implications, such as left ventricular hypertrophy, peripheral arterial occlusive disease and finally patient care costs, will be discussed.

Arterial Hypertension Induced by Erythropoietin and Erythropoiesis-Stimulating Agents (ESA)

“…Consistent with the observations that correction of anemia in ESRD patients by Epo induces hypersensitivity to norepinephrine and angiotensin II, as well as increased ET-1 concentration and impaired endothelial relaxation (20), several studies have shown significant increases in TPR (78,79). Cardiac output (CO) or cardiac index (CI) were shown by differing methodologies to decrease in response to Epo in most, but not all, studies (78 -84).…”

HEMATOLOGY: ISSUES IN THE DIALYSIS PATIENT: Nonhematologic Complications of Erythropoietin Therapy

“…Similar to both essential hypertension and renal failure‐associated hypertension, where increased peripheral vascular resistance is the primary cause, rHuEPO‐induced hypertension manifests similar hemodynamic changes. Systemic vascular resistance is increased by approximately 28%, while a concurrent decrease of cardiac output (6%) also occurs (10,11). Several mechanisms have been implicated in the pathogenesis of rHuEPO‐induced hypertension (Table 2).…”

Anemia during the Predialysis Period: A Key to Cardiac Damage in Renal Failure

“…The advent of EPO and the improvement in anemia in dialysis patients have, to some extent, caused an improvement in cardiac structure and function, with a reduction in the increased cardiac output and heart rate, an increase in the peripheral vascular resistance and venous tone, a decrease in left ventricular mass and hypertrophy, a reduction in left ventricular end-diastolic and end-systolic diameters, and an improvement in the ejection fraction [27]. Clinically there has been an increase in exercise capacity and a reduction in exercise-induced cardiac ischemia [27, 28, 29].…”

“…Clinically there has been an increase in exercise capacity and a reduction in exercise-induced cardiac ischemia [27, 28, 29]. In some patients on dialysis with ischemic heart disease, the cardiac output, despite the anemia, may not be increased but may actually be decreased because of reduced myocardial function secondary to the reduced oxygenation caused by the anemia [30].…”