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      Erythropoietin Impairs Endothelial Vasodilatory Function in Patients with Renal Anemia and in Healthy Subjects

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          Abstract

          Background/Aim: The mechanisms underlying the aggravation or development of hypertension frequently seen during treatment of renal anemia with epoetins are not fully elucidated. The aim of the present study was to investigate the effects of epoetin alfa on endothelial vasodilatory function in patients with renal anemia and in healthy subjects. Methods: Eighteen preuremic patients with anemia (GFR 23.4 ± 11 SD ml/min, Hb 101 ± 8 g/l) and 10 healthy subjects underwent evaluation of endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIDV) by means of forearm blood flow (FBF) measurements with venous occlusion plethysmography during local intra-arterial infusions of methacholine (MCh, evaluating EDV) and sodium nitroprusside (SNP, evaluating EIDV). These investigations were performed before and 30 min after an intravenous injection of epoetin alfa (10,000 IU). Ten healthy subjects underwent the same procedure with the exception that saline were given instead of epoetin. The patients were treated with epoetin alfa subcutaneously for 12–19 weeks and revaluated when Hb exceeded 120 g/l. Results: EDV was attenuated after the epoetin injection in both renal patients and healthy subjects. This impairment persisted after anemia had been treated. EDIV and blood pressure remained constant. Saline had no effect on the variables measured. Conclusion: Our results indicate that epoetin alfa impairs endothelial function in renal patients and healthy subjects which may have an impact on vascular complications.

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          Most cited references 15

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          Mechanism of erythropoietin-induced hypertension.

           N. Vaziri (1999)
          Chronic administration of erythropoietin (EPO) is associated with an increase in arterial blood pressure in patients and animals with chronic renal failure (CRF). Several mechanisms have been considered in the pathogenesis of EPO-induced hypertension. These include the possible role of the rise of hematocrit and erythrocyte mass, changes in production or sensitivity to endogenous vasopressors, alterations in vascular smooth-muscle ionic milieu, dysregulation of production or responsiveness to endogenous vasodilatory factors, a direct vasopressor action of EPO, and finally arterial remodeling through stimulation of vascular cell growth.
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            Effect of recombinant human erythropoietin treatment on blood pressure and some haematological parameters in healthy men.

             B Berglund,  B Ekblom (1991)
            The aim of this study was to evaluate the effect of treatment with subcutaneous injections of recombinant human erythropoietin (rhEpo), 20-40 IU kg-1 body weight, 3 times a week, on resting blood pressure, blood pressure response during submaximal exercise, some haematological parameters, and subjective side-effects in 15 healthy male subjects. RhEpo increased both haemoglobin (Hb) concentration and haematocrit (Hct) significantly, the values for Hb being 152 +/- 4.2 g l-1 before treatment and 169 +/- 9.3 g l-1 (mean values +/- SD) after 6 weeks of rhEpo treatment (P less than 0.001). The corresponding values for Hct were 44.5 +/- 1.5% and 49.7 +/- 1.9% (P less than 0.001), respectively. The systolic and diastolic blood pressure values at rest were unchanged after rhEpo treatment. A marked increase in systolic blood pressure was observed during submaximal exercise at 200 W, the initial and final values being 177 +/- 14.2 mmHg and 191 +/- 19.5 mmHg (P less than 0.01), respectively. Heart rate during exercise at 200 W was significantly lower after rhEpo treatment than before it: 144 +/- 15 beats min-1 compared to 136 +/- 8 beats min-1 (P less than 0.001). The leucocyte count remained unchanged after rhEpo treatment, but there was a significant decrease (P less than 0.05) in the number of lymphocytes. Reticulocyte and platelet counts were unchanged. Serum (S) ferritin decreased from 87.3 +/- 41.8 mmol l-1 to 59.3 +/- 27.8 mmol l-1 after rhEpo treatment (P less than 0.001). Serum-Na, S-K, S-Ca, S-creatinine, S-bilirubin, S-aspartate aminotransferase (ASAT), S-alanine aminotransferase (ALAT), and S-lactate dehydrogenase (LD) were unchanged after rhEpo treatment. No subjective side-effects were reported. In conclusion, low doses of rhEpo increased Hb levels and Hct by more than 10% after 6 weeks. Blood pressure at rest was unchanged, but rhEpo induced a markedly accentuated blood pressure reaction during exercise. A minor decrease in the lymphocyte count was observed, but electrolyte and creatinine levels remained unchanged after rhEpo treatment.
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              Low Nitric Oxide Production in Patients with Chronic Renal Failure

              Background: Rats with chronic renal failure have a low nitric oxide (NO) production and a diminished NO excretion. The supplementation of L -arginine has an inhibitory effect on the progression of renal insufficiency. Methods: The present study was designed to determine whether chronic renal failure patients have a low NO production. Plasma and urine nitrate (NO 3 ) and nitrite (NO 2 ), stable metabolites of NO, were measured in 83 consecutive patients with chronic renal failure. The 83 chronic renal failure patients were divided into three groups: group 1, mild renal failure (creatinine clearance >60 ml/min/1.73 m 2 ); group 2, moderate renal failure (creatinine clearance >30 2 ), and group 3, severe renal failure (creatinine clearance 2 ). Thirty-three healthy volunteers served as controls. Results: The daily urinary NO excretion was significantly lower in patients with moderate and severe renal failure as compared with those with mild renal failure and normal controls. The lowest values were found in the severe renal failure group. When the 24-hour urinary NO excretion or NO per milligram creatinine and the NO clearance were correlated with the renal function in all patients as a group, these parameters were directly correlated with the creatinine clearance and inversely correlated with the serum creatinine level. The plasma NO concentration was not different between the three chronic renal failure groups, but higher than in the controls. Plasma NO in renal failure patients was not correlated with the creatinine clearance or serum creatinine levels. Conclusions: Chronic renal failure is a state of NO deficiency. Treatment strategies to increase NO production ( L -arginine supplementation or other NO compounds) may prove to be useful in maintaining the renal function and slow the progression of renal disease.
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                Author and article information

                Journal
                NEC
                Nephron Clin Pract
                10.1159/issn.1660-2110
                Nephron Clinical Practice
                S. Karger AG
                1660-2110
                2006
                January 2006
                16 September 2005
                : 102
                : 1
                : c30-c34
                Affiliations
                aDepartment of Medical Sciences, University Hospital, Uppsala, Sweden;
                Article
                88308 Nephron Clin Pract 2006;102:c30–c34
                10.1159/000088308
                16166804
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 1, References: 20, Pages: 1
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/88308
                Categories
                Original Paper

                Cardiovascular Medicine, Nephrology

                Chronic renal failure, Endothelium, Epoetin alfa

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