Elevated level of erythropoietin in congestive heart failure Relationship to renal perfusion and plasma renin

Abstract

A severe reduction in renal perfusion in congestive heart failure appears to cause an increase in serum erythropoietin.

A Modern Understanding of the Traditional and Nontraditional Biological Functions of Angiotensin-Converting Enzyme

“…Further, losartan alone retarded the formation of CFU erythroid. It should be noted that a variety of clinical reports have observed an association between activation of the renin-angiotensin system and increased erythropoiesis (Jensen et al, 1993;Julian et al, 1994;Vlahakos et al, 1999;Cole et al, 2000). These studies come from analyses of patients with a variety of chronic diseases, including chronic obstructive pulmonary disease, heart failure, and renal transplantation.…”

Heart failure and anemia: mechanisms and pathophysiology

“…Only a few studies have examined the relation between renal blood flow and erythropoietin in patients with heart failure. Two studies, on a small number of patients, did find that renal blood flow was an independent determinant of erythropoietin secretion [40,41]. More recently, however, Westenbrink et al [21] could not confirm this in a larger subset of heart failure patients.…”

Anemia in Chronic Heart Failure

“…27,38,60 Accordingly, anemia in CHF may be responsive to exogenous erythropoietin supplementation. The primary mechanism by which erythropoietin stimulates red blood cell production is inhibition of apoptosis of bone marrow erythrocyte progenitors.…”

“…37 Erythropoietin levels are modestly increased in patients with CHF in proportion to measures of activation of the renin-angiotensin system. 38 Inhibition of the renin-angiotensin system with either ACE inhibitors or angiotensin receptor blockers is associated with decreased erythropoietin production and reduced hemoglobin levels. 12,39,40 ACE also catalyzes the breakdown of Ac-SDKP, a tetrapeptide inhibitor of erythropoiesis.…”