Genetic predisposition to hypertension facilitates blood pressure elevation in hemodialysis patients treated with erythropoietin

Ishimitsu, Toshihiko; Tsukada, Hiroki; Ogawa, Yoshiichi; Numabe, Atsushi; Yagi, Shigeru

doi:10.1016/0002-9343(93)90151-e

Cited by 48 publications

(18 citation statements)

References 23 publications

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“…Other reported factors include (3) the re-setting between the changes in body fluid volume associated with the improvement in anemia and the resistance of peripheral vessels, (4) the involvement of vasopressors such as endothelin, and (5) enhanced responsiveness to vasopressors such as angiotensin II. It has also been reported that patients with a family history and past history of hypertension tend to have hypertension because of the presence of risk for the disease [180]. A relationship between the inherited factors for hypertension and the T allele of M235T angiotensinogen gene polymorphism has also been reported [181].…”

Section: Rationale Hypertensionmentioning

confidence: 97%

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto¹,

et al. 2017

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Section: Rationale Hypertensionmentioning

confidence: 97%

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto¹,

et al. 2017

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“…The increase in blood pressure is not simply a function of hematocrit. Hemodialysis patients with a positive family history of hypertension are more susceptible to develop hypertension during rHu-EPO therapy than those with a negative family history (32). Patients with non-renal anemia do not develop hypertension on rHu-EPO therapy.…”

Section: Rhu-epo Therapy In Renal Failurementioning

confidence: 99%

Biology of erythropoietin

Jelkmann

Hellwig-Bürgel

2001

Advances in Experimental Medicine and Biology

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Abstract:Hypoxia induces tissue-specific gene products such as erythropoietin (EPO) and vascular endothelial growth factor (VEGF), which improve the peripheral O 2 supply, and glucose transporters and glycolytic enzymes, which adapt cells to reduced O 2 availability. EPO has been the fountainhead in research on P02-dependent synthesis of proteins . The EPO gene enhancer (Iike the tlanking DNA-elements of several other pOrcontrolled genes) contains a consensus sequence (CGTG) that binds the trans-acting dimeric hypox ia-inducible factor I (HlF-Ia/ß). The u-subunit of HIF-I is rapidly degraded by the proteasome under normoxic conditions, but it is stabilized on occurrence of hypoxia . HIF-I DNA-b inding is also increased by insulin, and by interleukin -I and tumor necrosis factor. Thus, in some aspects there is synergy in the cellular responses to hypoxia, glucose deficiency and intlammation. In viewing c1inical medicine recombinant human EPO (rHu-EPO) has become the mainstay oftreatment for renal anemia. Endogenous EPO and rHu-EPO are similar except for minor differences in the pattern of their 4 carbohydrate chains . RHu-EPO is also administered to patient s suffering from non-renal anemias, such as in autoimmune diseases or malignancies. The correction of anemia in patients with solid tumors is not merely considered a palliative intervent ion. Hypoxia prornotes tumor growth . However, the benefits of the administration of rHu-EPO to tumor patients with respect to its positive effects on tumor oxygenation, tumor growth inhibition and support of chemo-and radiotherapy is still debatable ground .

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“…149 Increase in BP with erythropoietin occurs more commonly in individuals with preexisting hypertension 150,151 or a family history of hypertension. 152 Prevention of erythropoietin-induced hypertension, and other complications, is a clinical challenge with several possible management strategies. Recommended strategies, with little good evidence to support these practices, have included the following: changing the route of administration (subcutaneous versus intravenous), reducing the goal hemoglobin level (especially in patients who are unresponsive to erythropoietin therapy), starting with a low erythropoietin dose and increasing the dose slowly, and avoiding the use of erythropoietin altogether.…”

Section: Nonvolume-dependent Causes Of Hypertension In Dialysis Patientsmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

157

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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Genetic predisposition to hypertension facilitates blood pressure elevation in hemodialysis patients treated with erythropoietin

Cited by 48 publications

References 23 publications

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Biology of erythropoietin

Assessment and Management of Hypertension in Patients on Dialysis

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