title: High-dose intravenous epoetin does not increase blood pressure in critically ill patients with acute kidney injury.
abstract: OBJECTIVE
  Treatment of renal anemia with erythropoietic stimulating agents sometimes increases blood pressure. It is uncertain whether this is due to direct vasoconstriction and/or increased red blood cell mass.
  
  
  METHODS
  We conducted a post-hoc analysis of 160 critically ill patients in the EARLYARF trial with elevated urinary γ-glutamyltranspeptidase and alkaline phosphatase, indicating acute kidney injury. Patients received 2 doses of intravenous (i.v.) epoetin (500 U/kg), 24 hours apart, or placebo, in a randomized, double-blind study design. Hourly intra-arterial mean arterial pressure (MAP), and norepinephrine equivalent dose (NED: determined using equipotency conversion factors for doses of epinephrine, vasopressin, phenlyephrine, or dopamine) were extracted from clinical records. The differences between baseline and maximum MAP and NED (ΔMAP and ΔNED) over 4, 24, 72-hour, and 30-day periods following study drug administration were compared between groups.
  
  
  RESULTS
  At baseline, MAP was 78 ± 14 mmHg in the epoetin group and 81 ± 15 mmHg in the placebo group (p = 0.22). There were no differences between groups in ΔMAP (6 ± 14 versus 7 ± 14 mmHg; p = 0.53), in ΔNED, or in ΔMAP adjusted for ΔNED at 4 hours, or at any time points. A subgroup analysis of only those patients not requiring vasopressor support (n = 71) also showed no differences between epoetin and placebo for all outcomes.
  
  
  CONCLUSIONS
  We concluded that intravenous high dose epoetin does not acutely increase blood pressure, suggesting no acute vasoconstrictor effect in this setting.
authors: Christchurch Kidney Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand.
authors: Azrina M
authors: AM
authors: Ralib
authors: John W
authors: JW
authors: Pickering
authors: Tamas
authors: T
authors: Major
authors: Suetonia C
authors: SC
authors: Palmer
authors: Geoffrey M
authors: GM
authors: Shaw
authors: David A
authors: DA
authors: Goodkin
authors: Zoltán H
authors: ZH
authors: Endre
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D016638:Critical Illness; D004311:Double-Blind Method; D004921:Erythropoietin / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000494:pharmacology; D012189:Retrospective Studies
chemical_list: D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin