The cardiovascular effects of erythropoietin

Abstract

Erythropoietin is a hypoxia-induced hormone that is essential for normal erythropoiesis. The production of recombinant human erythropoietin (rHuEpo) has revolutionized the treatment of anemia associated with chronic renal failure and chemotherapy, and has been used as prophylaxis to prevent anemia after surgery. The erythropoietin receptor is widely distributed in the cardiovascular system, including endothelial cells, smooth muscle cells and cardiomyocytes. Epo has potentially beneficial effects on the endothelium including anti-apoptotic, mitogenic and angiogenic activities. On the other hand, some reports suggest that rHuEpo may have pro-thrombotic or platelet-activating effects. Hypertension develops in 20-30% of renal patients treated with rHuEpo. Many patients with heart failure have anemia. Despite some potential adverse effects, early studies in heart failure patients with anemia suggest that rHuEpo therapy is safe and effective in reducing left ventricular hypertrophy, enhancing exercise performance and increasing ejection fraction. Further studies are warranted to define the role of rHuEpo in chronic heart failure and other cardiovascular settings.

Management of Anemia in Children Receiving Chronic Peritoneal Dialysis

“…Furthermore, erythropoietin can activate platelets, thereby potentially enhancing thrombosis risks when used in patients with preexisting cardiovascular disease. [28][29][30] Our study describes for the first time an association between mortality and high ESA dose in children and in a PD population. The link of high administered ESA doses with poor patient survival was independent of the Hb level achieved and more discriminative than the association of survival with the mean Hb level.…”

Mobilizing Endothelial Progenitor Cells

“…These beneficial effects of Epo may override potential Epo-related side effects such as elevated blood pressure and the incidence of thrombosis. 25 In addition to the use of cytokines to mobilize EPC from the bone marrow, several pharmacological substances have been shown to increase EPC numbers. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, have been developed as lipid-lowering drugs, but besides lipid-lowering, statins are capable of reducing vascular inflammation, decreasing platelet aggregation and thrombus deposition, and increasing endothelium-derived nitric oxide (NO) production.…”

Cardiovascular Risk Assessment in Diabetes and Chronic Kidney Diseases: A New Insight and Emerging Strategies

“…Early tubulointerstitial occurs which disease decreases EPO production and moreover inflammatory cytokines reduce EPO responsiveness leading to anaemia [174]. It is also associated with the level of albuminuria [128] .Anaemia in turn, increases the progression toward CKD, oxidative stress, tissue ischemia, ventricular stress and mortality [175][176][177]. Of interest, a recent study demonstrated the contribution of anemia to the frequent diastolic dysfunction in DM, as well as its association with brain natriuretic peptide (BNP) and suggested using this factor to identify diabetic patients at increased risk of cardiac dysfunction [175].…”