title: Recombinant human erythropoietin and its effects on macro- and microcirculation during normovolemia. A physiological study of hemodynamics, fluid status and skin microcirculation.
abstract: In 9 chronic hemodialysis patients, treated with recombinant human erythropoietin (rHuEpo), longitudinal studies were performed to investigate possible changes in macro- and microcirculatory parameters during normovolemia, as assessed echographically by determining the inferior vena cava diameter and adjusting dialysis dry weight. Hematocrit increased from 19 +/- 4 to 33 +/- 5% (p less than 0.001). Systemic vascular resistance increased from 1,020 +/- 259 to 1,283 +/- 245 dyn/s/cm-5 (p less than 0.02), while mean arterial pressure remained unchanged. Cardiac index decreased (4.9 +/- 1.4 to 3.8 +/- 0.9 liters/min/m2; p less than 0.02), caused by a decrease in heart rate (87 +/- 21 to 75 +/- 16 beats/min; p less than 0.02) and stroke index (59.9 +/- 15.2 to 51.0 +/- 10.7 ml/m2; p less than 0.02). Red blood cell volume increased (468 +/- 105 to 858 +/- 203 ml/m2; p less than 0.001) and plasma volume decreased inversely ([125I]-albumin; 2,008 +/- 338 to 1,664 +/- 225 ml/m2; p less than 0.001), whereas total blood volume remained unaltered (2,476 +/- 397 to 2,518 +/- 352 ml/m2; n.s.). Total body weight increased (57.8 +/- 12 to 62.1 +/- 12 kg; p less than 0.02), indicative of an anabolic effect of rHuEpo therapy. Skin capillary circulation as measured by transcutaneous oxymetry at 37 degrees C skin temperature impaired, reflected by the increase of the time to peak after arterial occlusion (82 +/- 21 to 121 +/- 25 s; p less than 0.02). The reactive hyperemic response following the release of occlusion showed a significant increase at high hematocrit (10.7 +/- 4.2 to 16.6 +/- 5.3 mm Hg; p less than 0.02), whereas resting transcutaneous Po2 values showed a slight but not significant increase (2.3 +/- 1.3 to 4.7 +/- 3.3 mm Hg; n.s.). The high number of pathological capillaries in hemodialyzed patients might be an additional factor for the increase in systemic vascular resistance.
authors.affiliation: Department of Nephrology, University Hospital Maastricht, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wirtz
authors.forename: K M
authors.initials: KM
authors.lastname: Leunissen
authors.forename: J W
authors.initials: JW
authors.lastname: van Esser
authors.forename: E C
authors.initials: EC
authors.lastname: Cheriex
authors.forename: D W
authors.initials: DW
authors.lastname: Slaaf
authors.forename: R S
authors.initials: RS
authors.lastname: Reneman
authors.forename: J P
authors.initials: JP
authors.lastname: van Hooff
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D004921:Erythropoietin / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D010953:Plasma Volume / Q000187:drug effects; D011994:Recombinant Proteins / Q000494:pharmacology; D006435:Renal Dialysis / Q000009:adverse effects; D012867:Skin / Q000098:blood supply*
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin