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Relationship between erythropoietin and chronic heart failure in patients on chronic hemodialysis
J Kumagai1, N Yorioka, H Kawanishi
1Second Department of Internal Medicine, Hiroshima University School of Medicine, Japan.
Insights
Patients with chronic heart failure on dialysis show elevated erythropoietin levels. This suggests cardiac dysfunction influences erythropoietin production, even in kidney disease patients.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Chronic kidney disease (CKD) patients on hemodialysis often have altered erythropoietin (EPO) levels.
- Cardiac dysfunction is a common complication in patients with end-stage renal disease.
- The interplay between cardiac function and EPO in dialysis patients is not fully understood.
Purpose of the Study:
- To investigate the relationship between blood erythropoietin levels and cardiac function in patients undergoing chronic hemodialysis.
- To compare EPO levels in hemodialysis patients with and without chronic heart failure.
Main Methods:
- A case-control study involving 15 hemodialysis patients with chronic heart failure (CHF) and 45 controls without cardiac dysfunction.
- Matched controls for gender, age, and dialysis duration.
- Measurement of serum erythropoietin, atrial natriuretic peptide (ANP), and brain natriuretic peptide (BNP) levels.
Main Results:
- Erythropoietin levels were significantly higher in the heart failure group (256.3 ± 481.8 mU/ml) compared to the control group (17.0 ± 10.0 mU/ml, P < 0.01).
- Eight of 15 CHF patients maintained hematocrit >30% without recombinant human erythropoietin (rHuEPO) therapy.
- EPO levels correlated significantly with ANP and BNP levels in the heart failure group (P < 0.01).
Conclusions:
- Heart failure is associated with significantly elevated erythropoietin levels in patients on chronic hemodialysis.
- Cardiac dysfunction may stimulate EPO production independently of anemia severity or rHuEPO treatment.
- Elevated EPO levels in CHF dialysis patients may reflect the severity of cardiac dysfunction.
Abstract:
In the present study, the relationship between the blood erythropoietin level and cardiac function was investigated in 15 patients on chronic hemodialysis who developed chronic heart failure. Another 45 patients without cardiac dysfunction were selected as a control group that was matched for gender, age, and the duration of dialysis. The erythropoietin level was 256.3 +/- 481.8 mU/ml in the heart failure group, which was significantly higher than that in the control group (17.0 +/- 10.0 mU/ml, P < 0.01). Eight of the 15 patients in the heart failure group maintained a hematocrit of more than 30% without receiving recombinant human erythropoietin therapy, whereas 29 of the 45 patients in the control group required erythropoietin. In the heart failure group, the erythropoietin level was significantly correlated with the levels of atrial natriuretic peptide and brain natriuretic peptide (P < 0.01). These results suggest that heart failure can increase the erythropoietin level in proportion to the severity of cardiac dysfunction, even in patients on long-term dialysis.