Normalization of Hematocrit in Hemodialysis Patients With Cardiac Disease Does Not Increase Blood Pressure

Conlon, Peter J.; Kovalik, Eugene C.; Schumm, Deb; Minda, Sharon; Schwab, Steve J.

doi:10.1081/jdi-100100885

Cited by 36 publications

(27 citation statements)

References 13 publications

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“…Standardized techniques were used by several studies that were included in this review. Erturk et al (37) did not observe substantial differences in the recordings when using a standardized technique, but others (23,30,33,34,36,40) did. Studies that used the standardized measurements had as much variability in the difference between pre/postdialysis BP and ambulatory measurements as did nonstandardized studies.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies enrolled consecutive or random patients (24,28 -30), but some selected normotensive individuals only (31) or hypertensive individuals only (21,25) or required the availability of a good acoustic window for performance of echocardiograms (32). Three trials had prespecified hematocrit cutoffs for ABP monitoring as a result of participation in anemia correction trials (23,33,34).…”

Section: Qualitative Analysismentioning

confidence: 99%

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Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

Agarwal

Peixoto

Santos

et al. 2006

Clinical Journal of the American Society of Nephrology

213

154

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H ypertension is perhaps one of the most pervasive problems of patients with ESRD. Although current guidelines that focus on cardiovascular disease in dialysis patients call for hypertension control as a top priority, the vast majority of patients who are on hemodialysis are hypertensive and control rates are poor (1). For practical reasons, BP assessment and antihypertensive treatment in patients with ESRD is performed on the basis of measurements that are made either immediately before or after dialysis. Such timehonored practice is widely accepted and formally recommended by clinical guidelines. The recent National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines suggest that predialysis and postdialysis BP should be Ͻ140/90 and Ͻ130/80 mmHg, respectively (2).Population-based studies, including the recent Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) (3) and Ohasama studies (4) and studies on patients who had hypertension and were referred to a specialist clinic in the Dublin Outcome Study (5), have demonstrated clearly that ambulatory BP monitoring (ABPM) provides more accurate prognostic information than office BP, an issue that seems to be of particular relevance in the elderly. In a recent analysis of the ABPM substudy of the Systolic Hypertension in Europe (Syst-Eur) trial (6), ABPM and clinic BP did not identify the same patients for antihypertensive treatment, and ABPM was a better predictor of cardiovascular outcomes than clinic BP. These considerations are of relevance to patients with ESRD because uremia is a strong catalyst of the aging process and because patients with ESRD are older, with an average age of 60 yr.Given that the population with ESRD is elderly and the relationship between ABPM and cardiovascular outcomes and total mortality has scarcely been studied, we examined the magnitude of the difference between ABPM and pre/postdialysis BP. We hypothesized that if there were substantial differences, especially when differences between the two methods of measurements were unpredictable, then the two methods of measurement may have differing prognostic significance. The primary objective of this systematic analysis was to determine the magnitude of the difference and the variability in the difference between BP that is recorded in the dialysis environment, before and after the dialysis procedure, and ABPM that is performed simultaneously in the hemodialysis population. Materials and MethodsPublished studies that had reported paired ABP and pre/postdialysis BP in patients who were undergoing conventional three times a Published online ahead of print. Publication date available at www.cjasn.org.

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Section: Discussionmentioning

confidence: 99%

Section: Qualitative Analysismentioning

confidence: 99%

Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

Agarwal

Peixoto

Santos

et al. 2006

Clinical Journal of the American Society of Nephrology

213

154

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“…Overall, the achieved Hb values of the experimental arms in this group of trials were in the range of 119 to 150 g/L and the achieved Hb values of the control arm were in the range of 90 to 120 g/L. Of the seven studies in this group, the Besarab et al (16), Berns et al (26), and Conlon et al (28) trials enrolled patients with severe cardiovascular disease (congestive heart failure or ischemic heart disease). The Besarab et al (16) trial was terminated at the third interim analysis when differences in mortality between the groups were recognized as sufficient to make it very unlikely that continuation of the study would reveal a benefit for the higher Hb target group.…”

Section: Trial Characteristicsmentioning

confidence: 99%

Hemoglobin Targets for the Anemia of Chronic Kidney Disease

Strippoli

Craig

Manno

et al. 2004

Journal of the American Society of Nephrology

142

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“…There is great variability in response to ESA treatment (67,70,71). Some patients require small dosages to achieve Hb targets; others require much higher dosages.…”

Section: Role Of Epo Responsivenessmentioning

confidence: 99%

“…However no detailed data on changes in antihypertensive regimens for the two groups were provided. In the second study reported (67), during the first 28 wk of the ramp up, changes in antihypertensive regimen were needed in only 15% of patients, and the frequency was identical in both groups; however, all investigators were encouraged to make downward adjustments in dry weight, if possible, as Hb increased (A.B. personal observation, 1994 -1995).…”

Section: Role Of Hypertensionmentioning

confidence: 99%

Mechanism of Increased Mortality Risk with Erythropoietin Treatment to Higher Hemoglobin Targets

Fishbane¹,

Besarab²

2007

Clinical Journal of the American Society of Nephrology

130

101

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Recent randomized, controlled trials indicate that there is a strong trend for increased risk for death or adverse composite outcomes with erythropoiesis-stimulating agent treatment in kidney disease to hemoglobin targets higher than those currently recommended. The failure of these trials to find a benefit of higher hemoglobin is in stark contrast to findings from large, observational, population-based studies that continue to demonstrate the association of low hemoglobin with adverse outcomes. The mechanisms for the adverse effect of higher hemoglobin targets that are seen in the randomized, controlled trials are poorly understood. This review explores hypotheses involving (1) the effect of achieved hemoglobin itself, (2) the role of erythropoiesis-stimulating agent treatment, (3) the use of iron supplementation, (4) increased blood pressure, and (5) erythropoiesis-stimulating agent hyporesponsiveness. Because the causal pathway has yet to be determined, further research is strongly encouraged. Clinical practice, however, should avoid erythropoiesis-stimulating agent treatment to higher hemoglobin targets, particularly in those with significant cardiovascular morbidity and those who require disproportionately high dosages of erythropoietin-stimulating agents to achieve recommended hemoglobin levels.

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Normalization of Hematocrit in Hemodialysis Patients With Cardiac Disease Does Not Increase Blood Pressure

Abstract: It is possible to increase hematocrit to normal levels in hemodialysis with the administration of Epoetin alfa. The increase in hematocrit from 30+/-3% to 42+/-3% is not associated with increased blood pressure.

Cited by 36 publications

References 13 publications

Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

Hemoglobin Targets for the Anemia of Chronic Kidney Disease

Mechanism of Increased Mortality Risk with Erythropoietin Treatment to Higher Hemoglobin Targets

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