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Recombinant erythropoietin (Epogen) improves cardiac exercise performance in children with end-stage renal disease
G R Martin1, J R Ongkingo, M E Turner
1Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Insights
Recombinant erythropoietin (Epogen) improved exercise tolerance in anemic children with end-stage renal disease. Short-term anemia correction enhanced exercise capacity, with no further gains at six months.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Physiology
- Hematology
Background:
- Anemia is a common complication in children with end-stage renal disease (ESRD).
- Anemia can negatively impact cardiac function and exercise capacity in pediatric ESRD patients.
- Recombinant erythropoietin (Epogen) is a treatment option for anemia in ESRD.
Purpose of the Study:
- To evaluate the effects of Epogen on cardiac performance in anemic children with ESRD.
- To assess changes in exercise tolerance and oxygen consumption following Epogen therapy.
- To compare short-term (1 month) and long-term (6 months) effects of Epogen treatment.
Main Methods:
- A cohort of children with ESRD and significant anemia (hematocrit < 30%) received Epogen (50 U/kg) three times weekly.
- Cardiac function was assessed using echocardiography and cardiac output measurements (acetylene rebreathing).
- Exercise tolerance was evaluated via modified Bruce treadmill tests, with measurements taken before, and 1 and 6 months after Epogen initiation.
Main Results:
- Epogen successfully increased hematocrit levels (from 21.7% to 33.4%, P=0.001).
- Exercise time significantly improved after 1 month of Epogen (10.3 to 11.2 min, P=0.01), with no further increase at 6 months.
- Resting oxygen consumption decreased after 1 month (P=0.01), while cardiac structure and function remained unchanged.
Conclusions:
- Short-term correction of anemia with Epogen improves exercise tolerance in children with ESRD.
- Long-term Epogen therapy does not lead to additional improvements in exercise capacity beyond the initial short-term gains.
- Epogen effectively treats anemia in pediatric ESRD without adverse effects on cardiac performance.
Abstract:
To determine the effects of anemia in children with end-stage renal disease, we studied cardiac performance before and 1 and 6 months after recombinant erythropoietin (Epogen). Children with end-stage renal disease were included if they had significant anemia [hematocrit (Hct) < 30%]. Epogen 50 U/kg was given subcutaneously or intravenously three times per week until the Hct was > or = 33%. Echocardiography, cardiac output (acetylene rebreathing), and treadmill (modified Bruce) tests were performed. Boys (9) and girls (9), 11.9 +/- 5.6 years, were given Epogen and the Hct increased (from 21.7 +/- 2.7% to 33.4 +/- 2.1%, P = 0.001). Heart rate decreased (P = 0.04) and stroke volume did not change. Blood pressure did not change. Cardiac thickness, chamber dimensions, left ventricular wall stress, velocity of circumferential fiber shortening, and indices of diastolic function were normal and did not change after Epogen. Exercise time increased (from 10.3 +/- 1.9 to 11.2 +/- 1.9 min, P = 0.01) after 1 month of Epogen. Resting oxygen consumption (VO2) decreased (from 7.8 +/- 1.8 to 6.9 +/- 1.4 ml/min per kg, P = 0.01) 1 month after Epogen and peak exercise VO2 did not change after Epogen. There were no differences in exercise tests between the 1 and 6 month measurements. Exercise tolerance improves after the short-term correction of anemia and there is no further improvement after long-term correction.