Failure of Blood Pressure to Increase following Erythropoietin Therapy in the Renoprival Status

Ng, De Santo; Manzo, M; Lanzetti, N; Capasso, Giovambattista; Ficociello, R; Anastasio, P; Esposito, Roberta

doi:10.1177/039139889201500304

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…There has been long-standing concern over the use of erythropoietin (EPO) therapeutically, in that administration of the hormone to patients with chronic renal failure prior to EPO administration [2], the high doses as well as the intravenous route of administration of the hormone [1], the presence of native kidneys [3,4], a genetic predisposition to hypertension [5] and possibly the young age of the patients [6]. There are reports showing that the increase in blood pressure is independent of the increase in haematocrit in some patients [7].…”

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confidence: 99%

Role of erythropoietin and nitric oxide in modulating the tone of human renal interlobular and subcutaneous arteries from uraemic subjects

Richards

Johns

1999

Clinical Science

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This study investigated potential reasons why erythropoietin (EPO) given therapeutically to patients with renal failure may increase peripheral, but not renal, vascular resistance. This was done by comparing the effects of EPO on resting tension in normal renal interlobular and subcutaneous vessels from uraemic patients. In human subcutaneous arteries from uraemic subjects, noradrenaline- and KCl-induced vasoconstrictions were enhanced when nitric oxide (NO) production was blocked with N(G)-nitro-L-arginine methyl ester (L-NAME), but were unaffected by EPO, while acetylcholine- and bradykinin-induced concentration-dependent relaxations were markedly attenuated by L-NAME, but not by EPO. The noradrenaline- and KCl-induced vasoconstrictions of human renal interlobular arteries were unaffected by the presence of L-NAME, but were attenuated by EPO (20 units.ml(-1)) by some 33% (P<0.01); this effect was enhanced by the co-administration of L-NAME. Acetylcholine and bradykinin caused comparable dilatations of the interlobular arteries; the response to the former was attenuated by L-NAME, but none of these responses were changed by EPO. EPO given alone, at a concentration of either 0.1 or 20 units.ml(-1), had no effect on basal resting tone. NO production mediated both acetylcholine- and bradykinin-induced relaxation in this vessel type. In contrast, in the interlobular arteries there was no indication of NO modulating the level of vasoconstriction, and it only mediated acetylcholine-induced dilation. These acute responses to EPO only partially explain its differential effects on the vasculature in renal failure.

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Section: Introductionmentioning

confidence: 99%

Role of erythropoietin and nitric oxide in modulating the tone of human renal interlobular and subcutaneous arteries from uraemic subjects

Richards

Johns

1999

Clinical Science

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Elevated endothelin-1 levels and persistent stage IV hypertension in a nonvolume overloaded anephric patient

Vajó

Moffitt

Parvathala

et al. 1996

American Journal of Hypertension

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Persistent hypertension after nephrectomy is in most cases due to increased fluid volume. Endothelin-1 is a potent endogenous vasoconstrictor peptide. Its role in the development and maintenance of hypertension is not completely understood, but it might be significant in some cases. We report a case of stage IV hypertension after nephrectomy with elevated endothelin-1 levels and no volume overload.

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A Case of Erythropoietin Induced Hypertension in a Bilaterally Nephrectomized Patient

et al. 2003

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Recombinant human erythropoietin (r-HuEPO) is an established tool for correction of renal anemia. It is well known that chronic administration of r-HuEPO often causes hypertension in dialysis patients. However, the mechanism of the r-HuEPO induced hypertension has not been fully elucidated. We report a case of r-HuEPO induced hypertension in an anephric patient. In this case, hemodialysis was started after removal of both kidneys because of rupture of an angiomyolipoma. Although mean blood pressure (BP) did not change during the period of rapid correction of renal anemia by blood transfusion, treatment with r-HuEPO significantly increased mean BP. Also, discontinuation of r-HuEPO resulted in a decrease in mean BP. These results suggested that r-HuEPO caused an elevation in BP in the absence of kidneys, and the elevation in BP was thought to be independent of an increase in hematocrit level or hypervolemia. We also investigated the role of nitric oxide (NO) in r-HuEPO induced alteration of BP. A significant negative correlation was found between a decrease in serum NO level and an increase in mean BP during the period of r-HuEPO administration. The results suggest that an inhibitory effect of r-HuEPO on NO production might be, at least in part, related to the r-HuEPO induced hypertension in this case.

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Failure of Blood Pressure to Increase following Erythropoietin Therapy in the Renoprival Status

Cited by 3 publications

References 8 publications

Role of erythropoietin and nitric oxide in modulating the tone of human renal interlobular and subcutaneous arteries from uraemic subjects

Role of erythropoietin and nitric oxide in modulating the tone of human renal interlobular and subcutaneous arteries from uraemic subjects

Elevated endothelin-1 levels and persistent stage IV hypertension in a nonvolume overloaded anephric patient

A Case of Erythropoietin Induced Hypertension in a Bilaterally Nephrectomized Patient

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