Cardiovascular Indications and Complications of Recombinant Human Erythropoietin

Abstract

Vekaria A, Gigani Y, Belemkar S

Exogenous recombinant human erythropoietin (rHuEPO) is a beneficial therapeutic agent for correction of anemia in chronic kidney disease (CKD), end-stage renal disease, chemotherapy, and has been used as prophylaxis to prevent anemia after surgery. The erythropoietin receptor is widely distributed in the cardiovascular system, including endothelial cells, smooth muscle cells and cardiomyocytes. RHuEPO has potentially beneficial effects on the endothelium including cytoprotective, mitogenic and angiogenic activities. Early studies in heart failure patients with anemia suggest that rHuEpo therapy is safe and effective in reducing left ventricular hypertrophy, enhancing exercise performance and increasing ejection fraction. The use of rHuEPO, however, may also be associated with distinct side effects. Although not clearly demonstrated, a relationship between an increased red blood cell count and thrombus formation. Some reports suggest that rHuEpo may have prothrombotic or alters platelet aggregatory responses. Most notable is hypertension (HTN), partial correction of anemia with intravenous rHuEPO causes HTN. CREATE study found a trend toward increased mortality risk with a higher Hb target of 13-15 g/dl. Therefore aiming for a higher hematocrit level is still a controversial issue in the management of anemia in renal failure. Despite some potential adverse effect.