Portolés J, Torralbo A, Martin P, Rodrigo J, Herrero J A, Barrientos A
Servicios de Nefrología y Cardiología, Hospital Universitario San Carlos, Madrid, Spain.
Am J Kidney Dis. 1997 Apr;29(4):541-8. doi: 10.1016/s0272-6386(97)90335-8.
Treatment with recombinant human erythropoietin (rHuEPO) has solved the problem of anemia in patients on dialysis. However, its application to predialysis patients has raised some doubts about its effects on the progression of renal disease and on blood pressure (BP) and hemodynamic regulation. We have prospectively studied over at least 6 months a group of 11 predialysis patients receiving rHuEPO treatment (initial dose, 1,000 U subcutaneously three times a week). Clinical assessment and biochemical and hematologic measurements were made once every 2 weeks. Twenty-four-hour ambulatory BP monitoring, echocardiography, and determination of neurohumoral mediators of hemodynamics were performed once every 3 months. An adequate hematologic response was found (hemoglobin, 11.7 +/- 0.4 g/dL v 9 +/- 0.3 g/dL) without changes in the progression of renal disease. A decrease in cardiac output and an increase in total peripheral resistance was seen as anemia improved. A trend toward decreased left ventricular (LV) thickness and a significant decrease in LV mass index (from 178.2 +/- 20.6 g/m2 to 147.3 +/- 20.6 g/m2) were observed. Blood pressure control did not improve; moreover, in some patients an increase in systolic values was detected by ambulatory BP. Casual BP remained seemingly stable. Sequential determinations of neurohumoral mediators of hemodynamic substances (endothelin, renin, norepinephrine, epinephrine, dopamine) failed to explain these results. Ambulatory BP reveals a worse control in some patients who were previously hypertensive and confirms the utility of this technique in the assessment of patients under erythropoietin treatment. The trend toward LV hypertrophy regression without improved BP control confirms the role of anemia among the multiple factors leading to LV hypertrophy in end-stage renal disease (ESRD), and opens therapeutic possibilities. Better control of BP may avoid a potential offsetting of beneficial effects that correcting anemia would have on the cardiovascular system.
重组人促红细胞生成素（rHuEPO）治疗已解决了透析患者的贫血问题。然而，将其应用于透析前患者引发了一些关于其对肾脏疾病进展、血压（BP）和血流动力学调节影响的疑问。我们对一组11例接受rHuEPO治疗（初始剂量为每周皮下注射三次，每次1000 U）的透析前患者进行了至少6个月的前瞻性研究。每2周进行一次临床评估以及生化和血液学测量。每3个月进行一次24小时动态血压监测、超声心动图检查以及血流动力学神经体液介质测定。结果发现有充分的血液学反应（血红蛋白，从9±0.3 g/dL升至11.7±0.4 g/dL），而肾脏疾病进展未发生变化。随着贫血改善，心输出量降低，总外周阻力增加。观察到左心室（LV）厚度有减小趋势，左心室质量指数显著降低（从178.2±20.6 g/m²降至147.3±20.6 g/m²）。血压控制未改善；此外，动态血压监测发现部分患者收缩压升高。偶测血压似乎保持稳定。对血流动力学物质（内皮素、肾素、去甲肾上腺素、肾上腺素、多巴胺）的神经体液介质进行连续测定未能解释这些结果。动态血压监测显示部分既往高血压患者的血压控制较差，并证实了该技术在评估促红细胞生成素治疗患者中的实用性。左心室肥厚消退但血压控制未改善的趋势证实了贫血在终末期肾病（ESRD）导致左心室肥厚的多种因素中所起的作用，并开启了治疗可能性。更好地控制血压可避免纠正贫血对心血管系统可能产生的有益作用被抵消。
