uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Heart rate variabilty is decreased in non-diabetic patients with chronic kidney disease and improves by hemoglobin normalization
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
Manuscript (Other academic)
URN: urn:nbn:se:uu:diva-93121OAI: oai:DiVA.org:uu-93121DiVA: diva2:166501
Available from: 2005-05-04 Created: 2005-05-04 Last updated: 2010-01-13Bibliographically 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

Open Access in DiVA

No full text

By organisation
Department of Medical Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 184 hits
ReferencesLink to record
Permanent link

Direct link