Effects of recombinant human erythropoietin on echocardiographic findings in elderly dialysis patients

Abstract

Twenty anaemic, normotensive and elderly patients on both haemodialysis and CAPD with left ventricular hypertrophy (LVH) were undergoing systematic echocardiographic analysis during treatment with recombinant human erythropoietin (rHuEPO) for 12 months. Before and after the rHuEPO treatment, M-mode and pulsed Doppler echocardiographic were performed and haemodynamic parameters were closely followed. Partial correction of anaemia resulted in a decrease in the LV end-diastolic diameter (LVEDD) from 56.0$2.0-49.2 f 2.0 mm (PcO.05) in HD patients and 50.5 f 4.M3.6 f 3.0 mm in CAPD patients (P = NS). Concomitantly the calculated mass index (LVMi) was reduced significantly from 232.3 f 21.8-185.9 f 11.4g/m2 in elderly haemodialysis patients. Heart rate and arterial pressure did not change during the study period. However, in CAPD patients there was no significant change in LVMi during the study period. We conclude that long-term amelioration of anaemia in dialysis patients could induce a regression of left ventricular hypertrophy. However, in CAPD patients, both myocardial and haemodynamic effects were less evident. CAPD could possibly modulate the haemodynamic changes associated with the rHuEPO treatment or CAPD itself impose less left ventricular wall stress in these elderly patients.

Epoetin alfa's effect on left ventricular hypertrophy and subsequent mortality

“…Table 1 shows the sample size and number of cohorts for each of the 7 clinical parameters studied. Change in Hb was the clinical parameter reported for the largest number of patients, with results available for 407 patients, distributed among 22 epoetin alfa-treated cohorts in 19 of the 26 clinical studies [2,8,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. The clinical parameter with the fewest patient results was LVESV, which was available for 84 patients from 4 epoetin alfa-treated cohorts, from 4 of the clinical studies [30,34,37,38].…”

“…1B) [1,6,26,29,33,34,38,[40][41][42]46,47]. The estimated decrease in LVMi with epoetin alfa treatment was 26.7 g/m 2 , which was approximately 15% less than the baseline value of 180 g/m 2 ( Table 4).…”

“…Epoetin alfa treatment was associated with approximately equal increases and decreases in EF (Fig. 1C) [2,8,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Individual study estimates varied between À5% and +10%, and this variation was statistically significant ( PV.001). Overall, the estimated increase in EF following epoetin alfa treatment was about 1.5% from the baseline value of 61.6%, an increase of approximately 2.5%.…”