title: Role of oxidative stress in cardiovascular effects of anemia treatment with erythropoietin in predialysis patients with chronic kidney disease.
abstract: OBJECTIVE
  Oxidative stress (OS) is involved in left ventricular hypertrophy (LVH). Short-term treatment with erythropoietin (EPO) in chronic kidney disease (CKD) complicated by anemia and LVH is associated with a reduction in left ventricular mass (LVM). We proposed to assess whether the pro-oxidant status of CKD influences these outcomes.
  
  
  METHODS
  Predialysis patients (n = 76) with CKD and hemoglobin (Hb) levels < 11 g/dl received EPO for 6 months. The effects of this anemia correction on LVH regression were evaluated using echocardiography. Patients with LVM decrease > 10% were considered "responders" (n = 25) to treatment and those with LVM change < 10% were considered "non-responders" (n = 24). Measurement of OS included plasma and erythrocyte oxidized (GSSG) and reduced (GSH) glutathione, GSH redox ratio (GSSG/GSH), erythrocyte glutathione peroxidase (GPx) and oxidized LDL (Ox- LDL).
  
  
  RESULTS
  49 patients completed the study. With EPO therapy, mean Hb levels increased from 9.9 ± 0.6 to 12.8 ± 1.5 g/ dl (p < 0.0001) and LVM index decreased from 69.2 ± 17.7 to 64.1 ± 19.6 g/m2.7 (p = 0.01). At 6 months, "non-responders" had higher systolic blood pressure, pulse pressure, GSSG and GSH redox ratio and lower GSH than "responders". In multivariate analysis, and following adjustment for confounding variables, systolic blood pressure and GSH redox ratio independently predicted LVH regression.
  
  
  CONCLUSIONS
  Blood pressure and plasma GSH redox ratio (a marker of OS) are important predictors of LVH regression in anemic predialysis patients treated with EPO.
authors.affiliation: Nephrology Service, Hospital Universitari de Tarragona Joan XXIII, IISPV, Tortosa, Spain. amartinezv.hj23.ics@gencat.cat
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez-Vea
authors.forename: Luis
authors.initials: L
authors.lastname: Marcas
authors.forename: Alfredo
authors.initials: A
authors.lastname: Bardají
authors.forename: Marta
authors.initials: M
authors.lastname: Romeu
authors.forename: Cristina
authors.initials: C
authors.lastname: Gutierrez
authors.forename: Carmen
authors.initials: C
authors.lastname: García
authors.forename: Teresa
authors.initials: T
authors.lastname: Compte
authors.forename: Rosa
authors.initials: R
authors.lastname: Nogues
authors.forename: Carmen
authors.initials: C
authors.lastname: Peralta
authors.forename: Montserrat
authors.initials: M
authors.lastname: Giralt
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005978:Glutathione / Q000097:blood; D019803:Glutathione Disulfide / Q000097:blood; D005979:Glutathione Peroxidase / Q000097:blood; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008077:Lipoproteins, LDL / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018384:Oxidative Stress / Q000187:drug effects*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D008077:Lipoproteins, LDL; D011994:Recombinant Proteins; C103998:epoetin beta; C099252:oxidized low density lipoprotein; D004921:Erythropoietin; D005979:Glutathione Peroxidase; D005978:Glutathione; D019803:Glutathione Disulfide