Systolic function impairment in higher erythropoietin requirement patients in hemodialysis

Abstract

Circulatory adaptation to hemodialysis (HD) depends on several inter-related factors, due to the particular patient and to technical procedures. The cardiac effects of nutritional status and the improvement that erythropoietin (r-HuEPO) treatment, through the reduction of anemia, can determine, were reported; r-HuEPO requirements are quite different, in different patients, while achieving similar haemoglobin end-point. Thirty-four patients on r-HuEPO and 11 patients not treated, all in hemodialysis, were studied by echocardiography at beginning and at the end of 3 consecutive dialysis sessions. Ejection fraction increased with hemodialysis in all patients of the control group. A slight and not significant decrease of ejection fraction was observed, as average, in the r-HuEPO treated patients. But, more in detail, 20 patients on r-HuEPO showed a worsening of systolic function with hemodialysis; in the other 14 patients on r-HuEPO, as in not treated control patients, systolic function improved. A significant difference between the two sub-groups on r-HuEPO was the higher drug dose requirement, associated with a slightly lower haemoglobin concentration, both observed in patients with decreased ejection fraction after hemodialysis. Moreover, a close relationship between higher r-HuEPO requirements and worsening of systolic function was observed. This trend is not associated with adequacy of dialysis and malnutrition. Patients with higher r-HuEPO requirement share a worse cardiac adaptation to hemodialysis and slightly lower haemoglobin levels.