The haemodynamic effects of correction of anaemia in haemodialysis patients using recombinant human erythropoietin

To evaluate the acute and long-term haemodynamic response to recombinant human erythropoietin (rHuEpo) correction of chronic anaemia in haemodialysis-supported patients. Prospective analysis of randomly chosen patients undergoing the multicentre phase III clinical recombinant erythropoietin trial. Chronic haemodialysis patients supported in one of two dialysis centres of a large urban tertiary referral centre. Thirteen of the 59 patients who met the criterion for participation in the multicentre clinical phase III trial of recombinant erythropoietin were randomly chosen. Mean age (42.6 years), and time on dialysis (3.4 years) was representative of the study population. Ten patients were receiving antihypertensive therapy, which remained unchanged throughout the study. Haemodynamic testing was done in a fasting state, in the supine position, utilising radionuclide angiocardiography. Plasma volume was determined by 125I-labelled serum albumin. Echocardiographic and hormonal evaluations were also performed at each haemodynamic evaluation. All testing was done immediately prior to first dose of drug, upon reaching target haematocrit, and at 6 months and 1 year of continued non-anaemia. Mean arterial pressure did not seem to change at any of the study periods, while total peripheral resistance did drop at target (34 +/- 2.5 vs 27.2 +/- 3.2 microns2, P = 0.05). Cardiac output (5.6 +/- 0.5 vs 7.6 +/- 0.8 l/min, P = 0.005) and stroke volume (77 +/- 9.6 vs 116 +/- 15.4 ml, P = 0.005) also rose at this same period but returned to baseline during later periods. Ejection fraction increased over baseline at both target and 1 year study points (50 +/- 2.7 vs 57.7 +/- 3 vs 63 +/- 4.3, P = 0.05) while the haematocrit was increased at target (21.8 +/- 0.9 vs 35.6 +/- 1.0, P less than 0.0005), and maintained at this new level throughout the study. Total blood volume (118 +/- 6.7 vs 100.4 +/- 8.1 ml/cm, P less than 0.05) and plasma volume (150 +/- 8.2 vs 108.5 +/- 9.4 ml/cm, P less than 0.001) decreased at 1 year. Recombinant human erythropoietin is effective in correcting the anaemia of chronic renal failure. Any haemodynamic changes which may be induced seem to occur early in the course of therapy, are different from those changes induced by blood transfusions, and tend to return to baseline with continued treatment.