Beneficial effect of atorvastatin on erythropoietin responsiveness in maintenance haemodialysis patients.
OBJECTIVE
To evaluate the effect of atorvastatin on erythropoietin responsiveness and whether this effect is mediated by C-reactive protein (CRP) reduction in prevalent dyslipidemic, haemodialysis patients.


METHODS
We studied prospectively 33 stable, iron-repleted haemodialysis patients with low-density lipoprotein cholesterol (LDL) > or =2.58 mmol/L, who received 20 mg atorvastatin aiming to achieve the target of LDL <2.58 mmol/L, over a period of 9 months. Twenty-five patients completed the study, 15 men, with mean age 66.1 +/- 8.2 years. The duration of haemodialysis was 56.6 +/- 63.1 months and 5/25 patients were diabetics. Total serum cholesterol, triglycerides, high-density lipoprotein cholesterol, LDL, haemoglobin, albumin, intact parathyroid hormone, serum iron, ferritin, total iron binding capacity, CRP and weekly dose of erythropoietin/body weight/haemoglobin were analysed.


RESULTS
Twenty of the 25 patients (80%) achieved the goal of LDL <2.58 mmol/L. There was a significant decrease in total cholesterol (5.77 +/- 0.88 to 4.16 +/- 0.96 mmol/L, P < 0.001) and LDL (3.59 +/- 0.77 to 1.94 +/- 0.77 mmol/L, P < 0.001). Haemoglobin increased from 121 +/- 11 to 126 +/- 7 g/L (P < 0.05), while weekly dose of erythropoietin/body weight/haemoglobin decreased significantly from 8.34 +/- 3.70 to 7.87 +/- 3.11 IU/kg per haemoglobin (P < 0.05). CRP decreased not significantly from 7.0 +/- 6.1 to 4.5 +/- 2.2 mg/L.


CONCLUSIONS
Dyslipidemia of haemodialysis patients was treated safely and effectively with atorvastatin, but a fifth of the patients failed to achieve the therapeutic target. Statin therapy resulted in a significant increase of haemoglobin levels and improvement of erythropoietin responsiveness without a significant reduction in CRP levels, suggesting that the beneficial effect of statins on erythropoietin responsiveness may be driven by a mechanism other than CRP reduction.
Department of Nephrology, General Hospital of Veria, Veria, Greece. johntsou@otenet.gr
Ioannis
I
Tsouchnikas
Evangelia
E
Dounousi
Stamatina
S
Papakonstantinou
Kyriakos
K
Ioannou
Apostolos
A
Kelesidis
Nikolaos
N
Kotzadamis
Kyriaki
K
Xanthopoulou
Dimitrios
D
Tsakiris
D000368:Aged; D000069059:Atorvastatin; D002097:C-Reactive Protein / Q000032:analysis; D008078:Cholesterol, LDL / Q000097:blood; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use*; D006435:Renal Dialysis
D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D004921:Erythropoietin; D002097:C-Reactive Protein; D000069059:Atorvastatin