Benefits and risks of protracted treatment with human recombinant erythropoietin in patients having haemodialysis.

Abstract

Fourteen patients with uraemic anaemia and having regular haemodialysis were given human recombinant erythropoietin in increasing doses, beginning with 24 U/kg thrice weekly. One patient was dropped from the study because of recurrent thrombosis of vascular access sites. In the other 13 patients, followed up for a mean of 9-1 months (range 8-11), haemoglobin concentrations increased from 62 (SD 8) to 105 (9) g/l. No antierythropoietin antibodies were detected during the study. The correction of anaemia was associated with a tendency to hyperkalaemia and a mild increase of unconjugated bilirubinaemia. In eight previously hypertensive patients antihypertensive treatment had to be reinforced, but in normotensive patients blood pressure did not change. Thrombosis of arteriovenous fistulas occurred in two patients and a cerebral ischaemic lesion in one.Protracted treatment with human recombinant erythropoietin evidently can maintain normal haemoglobin concentrations in uraemic patients over time. Full correction ofanaemia, however, may trigger some vascular problems, particularly in hypertensive patients and those with a tendency to thromboembolism.

The inhibitory factors of hematopoiesis in chronic hemodialysis patients treated with recombinant human erythropoietin.

“…Both were within normal limits. Throughout the study course, the adverse effects of rH:uEPO including hypertension and thrombosis (Casati et al 1987) were not observed.…”

“…It is reported that rHuEPO has been effective in virtually all anemic hemodialysis patients (Winearls et al 1986;Eschbach et al 1987;Bommer et al 1988; Urabe et al 1988;Eschbach 1989). It is known, however, that effectiveness of rHuEPO varies among dialysis patients (Winearls et al 1986;Casati et al 1987;Eschbach et al 1987), and there are a few cases who have resisted to rHuEPO therapy (Kahn et al 1988). Several conditions have been noted that interfere with or reduce the effectiveness of rHuEPO : osteitis fibrosa, iron deficiency, inflammatory states, and, possibly aluminum excess .…”

Blood Rheology and Hypertension in Hemodialysis Patients Treated with Erythropoietin

“…It is now well established that treatment with r-HuEPO will readily correct the anemia of patients maintained by chronic hemodialysis [1][2][3][4][5][6]. However, a major concern has been the development or aggravation of hypertension with the increment of hematocrits in the patients treated.…”

“…Recently, several reports have been forwarded [1][2][3][4][5][6] that demonstrate correction of the anemia of patients undergoing regular dialysis treat ment. However, with the increase of hematocrit and thereby blood viscosity many of the patients treated developed hypertension.…”

The use of erythropoietin in a Jehovah's Witness undergoing major surgery and chemotherapy

“…In view of previous reports of thrombotic problems in patients with chronic renal failure receiving erythropoietin (Winearls et al, 1986;Casati et al, 1987;Eschbach et al, 1987) it seems possible that a similar effect may have precipitated or exacerbated the episodes of caval thrombosis which this patient experienced.…”