Nephrol Dial Transplant (1992) 7: 1199-1206
© 1992 European Renal Association-European Dialysis and Transplant Association
research-article
Haemodynamic changes and physical performance at comparative levels of haemoglobin after long-term treatment with recombinant erythropoietin
1Renal Unit West Heidelberg, Victoria, Australia 2Department of Nuclear Medicine West Heidelberg, Victoria, Australia 3Department of Cardiology, Austin Hospital West Heidelberg, Victoria, Australia 4Department of Cardiology, Repatriation General Hospital West Heidelberg, Victoria, Australia
Correspondence and offprint requests to: Dr L.P. McMahon, Renal Unit, Churchill Hospital, Headington, Oxford OX3 7LJ, UK
Physical performance and haemodynamic parameters at rest and with exercise were compared in a prospective, cross-over fashion in 12 anaemic haemodialysis patients (Hb 6.4±0.5, mean ± SEM) at two levels of haemoglobin (Hb 9 and 12 g/dl) before and after long-term treatment with recombinant human erythropoietin (rHuEpo). Patients were divided into two groups and measurements made prior to treatment, upon reaching, and after 4 months at the first target Hb (9 g/dl group A, 12 g/dl group B), and after 4 months at the alternative target Hb. Tests included an exercise radionuclide ventriculogram, Doppler echocardiogram, and respiratory function exercise test. Compared to pretreatment, there was a significant reduction in resting pulse rate (P<0.001), and in pulse rate (P<0.001) and arterial lactate (P<0.01) concentrations at specified levels of exercise. Work capacity improved 60% (P<0.001), and left ventricular mass fell by 26% (P<0.001).Although cardiac output (CO) during and after exercise was reduced (P<0.05), resting CO, cardiac index, stroke volume and ejection fraction (rest and exercise) were not significantly altered. There appeared little benefit in having the higher target Hb: no significant difference could be found between target levels for almost any measure. In addition, despite marked improvement from pretreatment levels, performanceparameters were still below those of non-uraemic agematched controls. These results demonstrate the beneficial but incomplete effect ofrHuEpo on resting and exercise-related factors, and suggest that most improvement is achieved with modest increments in haemoglobin
Keywords: comparative; erthropoietin; excise; haemoglobin; haemodynamic
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