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Hemorheological and hemodynamic changes in predialysis patients after normalization of hemoglobin with epoetin-alpha
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Klinisk fysiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Klinisk fysiologi)
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2005 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, no 5, 399-404 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Changes in blood viscosity and total peripheral resistance may contribute to increased blood pressure during partial correction of renal anemia with erythropoietin. An increase in hemoglobin level is followed by decreases in cardiac output and left ventricular mass. We examined how normalization of hemoglobin in predialysis patients affects both hemorheological and hemodynamic variables.

MATERIAL AND METHODS: Twelve moderately anemic predialysis patients (hemoglobin 115.9+/-7.8 g/l) received epoetin-alpha with the aim of achieving a normal hemoglobin level (135-160 g/l). Hemorheological variables were measured using rotational viscometry. Cardiac index was determined by means of Doppler echocardiography.

RESULTS: After 48 weeks, the hematocrit level had increased from 37.9%+/-3.0% to 47.0%+/-3.1% (p<0.0001). Blood viscosity increased from 3.84+/-0.33 to 4.59+/-0.4 mPa x s (p<0.001). Blood viscosity standardized to a hematocrit level of 45% and a plasma viscosity of 1.31 mPa x s did not change. Plasma viscosity, erythrocyte aggregation tendency and erythrocyte fluidity remained unchanged. The cardiac index decreased from 2.64+/-0.57 to 2.19+/-0.72 l/min/m(2) (p<0.05). The total peripheral resistance index increased from 3270+/-985 to 4013+/-1046 (dyn x s/cm(5))m(2) (p<0.05). Blood pressure remained constant, but the amount of antihypertensive medication used increased by 30%.

CONCLUSIONS: Hemoglobin normalization in predialysis patients raised blood viscosity and total peripheral resistance due to an increase in hematocrit level, without other consistent hemorheological changes. Antihypertensive therapy had to be increased in many patients to maintain an acceptable blood pressure. The cardiac index was reduced, which may have prevented further development of left ventricular hypertrophy.

Place, publisher, year, edition, pages
2005. Vol. 39, no 5, 399-404 p.
Keyword [en]
Cardiac index, erythropoietin, hemorheology, predialysis, total peripheral resistance
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93120DOI: 10.1080/00365590500192355PubMedID: 16257842OAI: oai:DiVA.org:uu-93120DiVA: diva2:166500
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2010-10-15Bibliographically 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.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 44
Keyword
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
Identifiers
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
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Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2010-10-15Bibliographically approved

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Furuland, HansLinde, TorbjörnSandhagen, BoAndrén, BertilWikström, Björn

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