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Reduced hemodialysis adequacy after hemoglobin normalization with epoetin
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2005 (English)In: JN. Journal of Nephrology (Milano. 1992), ISSN 1121-8428, Vol. 18, no 1, 80-85 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Increased hemoglobin (Hb) levels and higher blood viscosity could reduce hemodialyzer clearance. We examined hemodialysis (HD) adequacy after treatment with epoetin alfa aimed at normalizing Hb levels.

METHODS: Thirty-three HD patients were randomly allocated to achieve a normal Hb level (135-160 g/L) or a subnormal (control) Hb level of 90-120 g/L. HD adequacy was assessed by Kt/V measurement.

RESULTS: In the 24 evaluable patients, Hb levels reached 144 +/- 11 g/L in the normal Hb group (n=10) and 109 +/- 10 g/L in the subnormal group (n=14). Single-pool Kt/V decreased from 1.25 +/- 0.19 to 1.15 +/- 0.13 (p<0.01) in the normal Hb group, but remained constant in the subnormal group (1.26 +/- 0.26 and 1.26 +/- 0.28).

CONCLUSIONS: Normalization of Hb with epoetin alfa in HD patients resulted in a slight but statistically significant reduction in Kt/V. Therefore, when Hb is normalized, an increased dialysis dose could be necessary to maintain dialysis adequacy

Place, publisher, year, edition, pages
2005. Vol. 18, no 1, 80-85 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-93119PubMedID: 15772927OAI: oai:DiVA.org:uu-93119DiVA: diva2:166499
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2010-10-14Bibliographically approved
In thesis
1. Effects of Hemoglobin Normalization with Epoetin in Chronic Kidney Disease
Open this publication in new window or tab >>Effects of Hemoglobin Normalization with Epoetin in Chronic Kidney Disease
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anemia is common in patients with chronic kidney disease (CDK), contributes to reduced Quality of Life (QoL) and is associated with cardiovascular disease, morbidity and mortality. Epoetin raises hemoglobin (Hb) and increases QoL and physical exercise capacity. Because of concerns about safety and economics, current anemia treatment with epoetin aims to achieve subnormal Hb (110-120 g/l). Normalization of Hb may be of additional benefit regarding QoL and cardiovascular effects. The present study examines the effects of Hb normalization with epoetin on safety variables, QoL, graft function after kidney transplantation, dialysis adequacy, hemorheology, hemodynamics and cardiac autonomic function in CKD patients.

In a randomized, multicenter study comprising 416 pre-dialysis and dialysis patients no difference was observed between patients treated to a normal or a subnormal Hb level on mortality, thrombovascular events, serious adverse events, vascular access thrombosis and residual renal function. QoL was enhanced in a subgroup of hemodialysis patients. Pretransplant epoetin treatment directed toward normal Hb levels did not result in worse graft function during 6 postoperative months. Dialysis adequacy was reduced in a subgroup of hemodialysis patients after normalization of Hb. The blood flow properties of pre-dialysis patients were altered. The hemorheological investigation demonstrated that Hb normalization caused a parallel increase in hematocrit and blood viscosity without other hemorheological changes. While the total peripheral resistance index increased, the cardiac index (CI) decreased. In a separate study cardiac autonomic function, measured by heart rate variability, was decreased in pre-dialysis patients. It was improved, but not fully normalized, by Hb normalization.

On the basis of this study, Hb normalization with epoetin appears to be safe and increases QoL in hemodialysis patients though may result in lower dialysis adequacy and increased blood pressure. A reduction in CI and improved cardiac autonomic function indicate a positive effect on cardiovascular function.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 67 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 44
Internal medicine, Anemia, blood viscosity, cardiac output, chronic kidney disease, renal dialysis, dialysis adequacy, erythopoietin, heart rate variability, hemoglobin, hemorheology, hypertension, kidney transplantation, Kt/V, left ventricular hypertrophy, Quality of Life, Invärtesmedicin
National Category
Clinical Medicine
urn:nbn:se:uu:diva-5816 (URN)91-554-6265-0 (ISBN)
Public defence
2005-05-31, Enghoffsalen, Ing. 50, Akademiska sjukhuset, Uppsala, 13:15
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2010-10-15Bibliographically approved

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Furuland, HansLinde, TorbjörnWikström, Björn
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