Effects of Recombinant Human Erythropoietin on Intradialytic Changes in Plasma Concentration of Vasoactive Substances

Choi, Kyu Bok

Abstract

Recombinant human erythropoietin(rHuEPO) therapy has been associated with new onset or exacerbated hypertension. But there are debates on the mechanism for the new onset or exacerbated hypertension after rHuEPO. We have studied the effects of rHuEPO on intradialytic changes in plasma concentration of vasoactive substances. The plasma concentrations of vasoactive substances were investigated before and after hemodialysis in 15 nondiabetic patients with chronic renal failure. The hemodialysis were performed for 210 to 300min by using bicarbonate dialysate. A hemophan dialyzer was used. Blood pressure were measured every 30 min by using Centrysystem(R)3 BP monitor. Patients were grouped into two groups; one was EPO group treated with rHuEPO(n=7, 4000-6000U/week for more than 3 months) and the other was Non-EPO group (n=8, treated without rHuEPO). beta-endorphin, motilin and mean arterial blood pressure(MABP) were unchanged in the EPO group. In contrast, in the Non-EPO group, an increase in beta-endorphin(154.4 +/- 46.3 to 208.3 +/- 68.1pg/mL, p < 0.05) and a decrease in motilin(221.1 +/- 43.1 to 70.6 +/- 7.1pg/mL, p < 0.05) occurred. MABP decreased gradually until 3 hours after start of hemodialysis in these groups. Arginine vasopressin decreased in both groups. But angiotensin II, endothelin-1 and atrial natriuretic peptide were unchanged in both groups. These results indicate that rHuEPO administration have effects on the intradialytic changes in plasma concentration of vasodialtors during bicarbonate hemodialysis. Moreover, the above results suggest that rHuEPO administration may have effects on hemodynamic stability and gastrointestinal function during bicarbonate hemodialysis.