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Cardiovascular function in a chronic peritoneal dialysis pediatric population on recombinant human erythropoietin
S Bassi1, G Montini, A Edefonti
1Department of Nephrology, Children's Hospital, Brescia, Italy.
Insights
Recombinant human erythropoietin (rHuEPO) therapy improved anemia in children on dialysis by reducing heart rate, indicating a less hyperkinetic state. Left ventricular function remained normal despite increased blood pressure.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Physiology
- Hematology
Background:
- Anemia in chronic peritoneal dialysis (CPD) patients can lead to myocardial dysfunction via a hyperkinetic state.
- Understanding the cardiovascular impact of anemia treatment is crucial for managing these patients.
Purpose of the Study:
- To evaluate the cardiovascular effects of recombinant human erythropoietin (rHuEPO) therapy in anemic children undergoing CPD.
- To assess changes in cardiac function and hemodynamics during anemia correction.
Main Methods:
- A longitudinal study of 10 anemic children on CPD over 18 months of rHuEPO treatment.
- Monitoring of hemoglobin (Hb), heart rate (HR), mean arterial pressure (MAP), left ventricular dimensions (EDLVD, IVS), and shortening fraction (SF).
Main Results:
- rHuEPO therapy successfully increased Hb levels and decreased HR.
- Mean arterial pressure (MAP) increased, while left ventricular end-diastolic diameter (EDLVD) decreased.
- Shortening fraction (SF) and interventricular septal thickness (IVS) remained unchanged.
- A significant correlation was found between Hb correction and HR reduction (p < 0.01).
Conclusions:
- Anemia correction with rHuEPO in pediatric CPD patients primarily reduces the hyperkinetic state, evidenced by decreased HR.
- Left ventricular function and dimensions are preserved during treatment, despite an increase in MAP.
- rHuEPO therapy appears safe for cardiovascular function in this population.
Abstract:
Anemia, through a hyperkinetic state, is an important contributor to myocardial function impairment. To determine the cardiovascular effects of recombinant human erythropoietin (rHuEPO) therapy, 10 chronic peritoneal dialysis (CPD)-treated anemic children were studied before and during 18 months of treatment. The following parameters were recorded: hemoglobin (Hb) [percent of target level (TL) = x-2 standard deviations of normal Hb values for age and sex], heart rate (HR, beats/minute), mean arterial pressure (MAP, mmHg), end-diastolic left ventricular diameter (EDLVD, mm/sm BSA), shortening fraction (SF, percent), and interventricular septal thickness (IVS, mm/sm BSA). Student's t-test for paired data showed (vs time before treatment, T0) a progressive increase in Hb, a progressive decrease in HR, and a progressive increase in MAP. EDLVD progressively decreased, while SF and IVS remained unchanged throughout the study. Regression analysis showed a close correlation between anemia correction and decrease of HR (p < 0.01), while no correlation was found between Hb and EDLVD or SF, IVS, or MAP. Our data indicate that anemia correction in these patients is mainly associated with a decrease in hyperkinetic state (HR reduction with SF unvaried), while left ventricular function and dimensions remain normal, despite an increase in MAP.