Physiological basis for the use of erythropoietin in critically ill patients at risk for acute kidney injury.
OBJECTIVE
Acute kidney injury (AKI) frequently occurs in critically ill patients and is an independent risk factor for poor outcome. The prevention of kidney injury in intensive care remains a great challenge as specific nephroprotective therapies are still lacking. The present review summarizes recent evidence for the use of erythropoietin as a promising candidate to provide protection from AKI.


RESULTS
Beyond the known hematopoietic actions of erythropoietin, a number of preclinical studies demonstrated that erythropoietin possesses pleiotropic, organ-protecting properties. Preconditional and postconditional erythropoietin treatment was shown to protect from ischemic, toxic and septic AKI. Despite heterogeneities in study design and dose, erythropoietin consistently ameliorated renal injury. The mechanisms of protection remain largely unclear but may involve reduction of apoptosis, induction of cellular proliferation and tissue repair as well as mobilization of stem cells.


CONCLUSIONS
Animal studies revealed a physiological basis for the use of erythropoietin in AKI, which may be clinically applicable to prevent AKI in critically ill patients, but clinical studies are still lacking.
Bernhardt
Wanja M
WM
Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. wanja.bernhardt@uk-erlangen.de
Eckardt
Kai-Uwe
KU
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D048868:Adaptor Proteins, Signal Transducing / Q000378:metabolism*; D002352:Carrier Proteins / Q000378:metabolism*; D016638:Critical Illness; D004921:Erythropoietin / Q000627:therapeutic use*; D006410:Hematopoiesis; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins; D011994:Recombinant Proteins; D017411:Ribonucleoproteins, Small Nuclear; D012307:Risk Factors; D025521:Tumor Suppressor Proteins / Q000378:metabolism
D048868:Adaptor Proteins, Signal Transducing; D002352:Carrier Proteins; C403671:DELEC1 protein, human; D047908:Intracellular Signaling Peptides and Proteins; D011994:Recombinant Proteins; D017411:Ribonucleoproteins, Small Nuclear; C431323:SART1 protein, human; D025521:Tumor Suppressor Proteins; D004921:Erythropoietin