LONG-TERM MYOCARDIAL EFFECTS OF CORRECTION OF ANEMIA WITH RECOMBINANT-HUMAN-ERYTHROPOIETIN IN AGED PATIENTS ON HEMODIALYSIS

Long-term myocardial effects of recombinant human erythropoietin (rhEPO) therapy were investigated in nine hemodialysis (HD) patients greater than 60 years of age. Echocardiographic studies were performed before the administration of rhEPO with a hematocrit of 20.8% ± 1.9% and repeated after 6 (period I) and 24 months (period II) of treatment, when the hematocrit was increased to 34.1% ± 2.3% and 32.3% ± 2.8%, respectively. Left ventricular diameters were not significantly changed by rhEPO, although they tended to decrease at the end of the study (30.6 ± 5.3 v 27.7 ± 3.6 mm systole, and 50.3 ± 3 v 46.5 ± 3.7 mm diastole). Thickness of the interventricular septum and left ventricular posterior wall remained unaltered, although there was a downward trend (14.5 ± 5.2 to 12.8 ± 2.8 mm and 11.7 ± 1.9 to 10.6 ± 1.4 mm, respectively). Left ventricular mass index (LVM) progressively decreased from 181.5 ± 61 to 153.8 ± 38.3 (period I) and 135.7 ± 45.6 g/m2 (period II, P < 0.05). Stroke volume remained unaltered in period I, but it decreased from 93.7 ± 10 to 65.2 ± 12.8 mL (P < 0.001) in period II, resulting in a decrease of cardiac index (CI) from 3.93 ± 0.86 to 2.54 ± 0.68 L/min/m2 (P < 0.001) at the end of the study. Heart rate did not change during the study period. Blood pressure was kept constant, although anti hypertensive therapy needed to be adjusted to prevent occurrence or aggravation of hypertension in two patients. We conclude that long-term rhEPO therapy in aged patients on HD has beneficial myocardial effects, with normalization of cardiac output (CO) and recovery of left ventricular hypertropy (LVH). Whether regression of LVH is associated with improved survival in these patients remains to be established. © 1992, National Kidney Foundation, Inc.. All rights reserved.