Hemodynamics of Uremic Anemia

Neff, Martin S.; Kim, Kwan E.; Persoff, Michael; Onesti, Gaddo; Swartz, Charles

doi:10.1161/01.cir.43.6.876

Cited by 234 publications

(83 citation statements)

References 23 publications

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“…Unfortunately, there is only one study, performed almost 40 yr ago, that reports the hemody- namic response to a nonpharmacologic increase in Hct (blood transfusions), in six hemodialysis patients (86). After blood transfusions, CI correlated inversely (Figure 3), whereas TPR and DBP correlated directly, with Hct.…”

Section: Esa Versus Transfusion-induced Alterations In Hemodynamic Pamentioning

confidence: 99%

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

Krapf¹,

Hulter²

2009

Clinical Journal of the American Society of Nephrology

163

121

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This review summarizes the evidence for a hypertensinogenic effect of Erythropoietin (Epo) in normal human subjects and predialysis, hemodialysis, and continuous ambulatory peritoneal dialysis (CAPD) patients. The possible mechanisms of Epo-induced hypertension are examined with in vivo animal and in vitro data, as well as pathophysiological human studies in both normal subjects and CKD patients. The evidence for a hypertensinogenic effect of erythropoiesis-stimulating agents (ESAs) in normal subjects, predialysis CKD, hemodialysis, and CAPD patients is compelling. Epo increases BP directly and notably independently of its erythropoietic effect and its effect on blood rheology. The potential for the development of future agents that might act as specific stimulators of erythropoiesis, devoid of direct hemodynamic side effects is underscored.

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Section: Esa Versus Transfusion-induced Alterations In Hemodynamic Pamentioning

confidence: 99%

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

Krapf¹,

Hulter²

2009

Clinical Journal of the American Society of Nephrology

163

121

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“…There is a correlation between hematocrit and cardiac output in ESRD patients [43]. When an anemic renal disease patient is transfused, peripheral vascular resistance increases, systolic blood pressure increases, and the cardiac index decreases as the hematocrit increases [43].…”

Section: Plasma Volume Effectsmentioning

confidence: 99%

“…When an anemic renal disease patient is transfused, peripheral vascular resistance increases, systolic blood pressure increases, and the cardiac index decreases as the hematocrit increases [43]. These changes are associated with a decrease in plasma volume because of the body's tendency to maintain a constant blood volume.…”

Section: Plasma Volume Effectsmentioning

confidence: 99%

Anemia Management in Oncology and Hematology

2009

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Anemia is frequent in cancer patients and its incidence increases with chemotherapy. The probability of requiring transfusions also increases with chemotherapy. Anemia negatively impacts survival and accentuates fatigue in cancer patients. Cancer promotes inflammatory cytokine production, which suppresses erythropoiesis and erythropoietin (EPO) production. Erythropoiesis-stimulating agents (ESAs) improve erythropoiesis and reduce transfusion needs in anemic cancer patients receiving chemotherapy. However, meta-analyses have shown an increased risk of thromboembolic (TE) events with ESA use during chemotherapy, but not increased on-study mortality or reduced overall survival. Three reasons have been proposed to explain why ESAs might have adverse effects in anemic cancer patients: tumor progression due to stimulation of tumor cell EPO receptors; increased risk of TE; and reduced survival. However, erythropoietin is not an oncogene, nor is the EPO receptor. It has also been demonstrated that erythropoietin does not stimulate tumor proliferation. Increased TE risk associated with ESAs is probably a consequence of increased blood viscosity due to excessive RBC mass elevation with concomitant plasma volume contraction, nitric oxide scavenging, and endothelial cell activation. Increased ESA dosing may also impact survival negatively because EPO contracts the plasma volume and stimulates inflammatory cytokine production independently of increasing erythropoiesis. Furthermore, transfusions themselves are associated with an increase in TE and plasma volume contraction, and these events are potentiated when ESAs are given with transfusions. An update on the management of anemia in oncology, the potential adverse events of ESAs, the benefits and risks of transfusions, and QoL are discussed in this paper. The

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“…Earlier human studies of hemodynamic changes after hemodialysis in patients with chronic renal failure were confined to the demonstration of alterations in cardiac output, heart rate, systemic arterial pressure, and peripheral vascular resistance (7)(8)(9)(10)(11). The advent of noninvasive techniques has permitted a more comprehensive evaluation of left ventricular function in patients in chronic renal failure and of the effects of hemodialysis (12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state.

Nixon¹,

Mitchell²,

McPhaul³

et al. 1983

J. Clin. Invest.

100

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A B S T R A C T Prior studies of the effect of hemodialysis on left ventricular function have not distinguished between the removal of uremic toxins and the change in cardiac filling volume. To separate these effects, left ventricular function was examined by serial echocardiography in five stable hemodialysis patients before and after three different dialysis procedures: (a) hemodialysis with volume loss, (b) ultrafiltration (volume loss only), and (c) hemodialysis without volume loss. The patients were similarly studied under control conditions and after increased (50 of headdown tilt for 90 min) and decreased (lower body negative pressure) cardiac filling volume.After hemodialysis with volume loss, end-diastolic volume (EDV) decreased from 167 to 128 ml (P < 0.001) and end-systolic volume (ESV) decreased from 97 to 51 ml (P < 0.001) without a change in stroke volume (SV). Ejection fraction increased from 42 to 52% (P < 0.001) and mean velocity of circumferential fiber shortening (VCF) increased from 0.61 to 1.04 circumferences (circ)/s (P < 0.001). After ultrafiltration, EDV decreased from 167 ml to 124 ml (P < 0.001) and SV from 73 ml to 39 ml (P < 0.001), without significant changes in ESV or VCF. In contrast to the maneuvers in which volume loss occurred, after hemodialysis without volume loss ESV decreased from 95 to 66 ml (P < 0.001) and SV increased from 74 ml to 97 ml (P < 0.001) without changes in EDV. EF increased from 44 to 59% (P < 0.001) and VCF increased from 0.64 to 1.26 circ/s (P < 0.001). Ventricular function curves plotted from data obtained under conditions of altered cardiac filling volume before and after the three dialysis maneuvers demonstrate that ultrafiltration produced a pure Frank-Starling effect, while Received for publication 9 March 1982 and in revised form 23 August 1982. hemodialysis with or without volume loss produced a shift in the ventricular function curves, which demonstrated an increase in the contractile state of the left ventricle. The changes in left ventricular function produced by regular hemodialysis are the combined effects of a decrease in EDV and an increase in the contractile state of the left ventricle.

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Hemodynamics of Uremic Anemia

Cited by 234 publications

References 23 publications

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

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

Anemia Management in Oncology and Hematology

Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state.

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