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Arch Dis Child. 1993 May; 68(5): 644–648.
PMCID: PMC1029333

Short term correction of anaemia with recombinant human erythropoietin and reduction of cardiac output in end stage renal failure.


Children with end stage renal failure and anaemia have an increased cardiac index and often gross ventricular hypertrophy. The contribution of anaemia to these abnormalities is uncertain. Eleven children with end stage renal failure and anaemia (haemoglobin concentration < 90 g/l) were enrolled into a single blind, placebo controlled, crossover study to assess the cardiovascular effects of reversing anaemia using subcutaneous human recombinant erythropoietin (r-HuEpo). Each limb lasted 24 weeks; seven children completed both limbs of the study. Haemoglobin increased with r-HuEpo, remaining above 100 g/l for a mean of 11 weeks. Cardiac index fell as a result of a reduction in both left ventricular stroke volume and heart rate. Left ventricular end diastolic diameter also decreased. In five children left ventricular wall thickness and left ventricular mass decreased with r-HuEpo, but this failed to reach significance for the whole group. Blood pressure did not change in six normotensive children completing an r-HuEpo limb; the decrease in cardiac index was therefore balanced by an increase in peripheral vascular resistance. Three children were taking anti-hypertensive treatment at the start of the study; one required an increase, and one a decrease, in treatment during the r-HuEpo limb. Short term treatment with r-HuEpo reduces cardiac index. A longer study is needed to determine whether this will, in time, result in a significant reduction in left ventricular hypertrophy.

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Selected References

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  • Demography of dialysis and transplantation in children in Europe, 1984. Report from the European Dialysis and Transplant Association Registry. Nephrol Dial Transplant. 1986;1(1):9–15. [PubMed]
  • Morris KP, Skinner JR, Wren C, Hunter S, Coulthard MG. Cardiac abnormalities in end stage renal failure and anaemia. Arch Dis Child. 1993 May;68(5):637–643. [PMC free article] [PubMed]
  • Neff MS, Kim KE, Persoff M, Onesti G, Swartz C. Hemodynamics of uremic anemia. Circulation. 1971 Jun;43(6):876–883. [PubMed]
  • Teruel JL, Pascual J, Jiménez M, Liaño F, Rivera M, Martínez J, Moya JL, Ortuño J. Hemodynamic changes in hemodialyzed patients during treatment with recombinant human erythropoietin. Nephron. 1991;58(2):135–137. [PubMed]
  • Pascual J, Teruel JL, Moya JL, Liaño F, Jiménez-Mena M, Ortuño J. Regression of left ventricular hypertrophy after partial correction of anemia with erythropoietin in patients on hemodialysis: a prospective study. Clin Nephrol. 1991 Jun;35(6):280–287. [PubMed]
  • Robson SC, Murray A, Peart I, Heads A, Hunter S. Reproducibility of cardiac output measurement by cross sectional and Doppler echocardiography. Br Heart J. 1988 Jun;59(6):680–684. [PMC free article] [PubMed]
  • Cannella G, La Canna G, Sandrini M, Gaggiotti M, Nordio G, Movilli E, Maiorca R. Renormalization of high cardiac output and of left ventricular size following long-term recombinant human erythropoietin treatment of anemic dialyzed uremic patients. Clin Nephrol. 1990 Dec;34(6):272–278. [PubMed]
  • London GM, Zins B, Pannier B, Naret C, Berthelot JM, Jacquot C, Safar M, Drueke TB. Vascular changes in hemodialysis patients in response to recombinant human erythropoietin. Kidney Int. 1989 Nov;36(5):878–882. [PubMed]
  • Tagawa H, Nagano M, Saito H, Umezu M, Yamakado M. Echocardiographic findings in hemodialysis patients treated with recombinant human erythropoietin: proposal for a hematocrit most beneficial to hemodynamics. Clin Nephrol. 1991 Jan;35(1):35–38. [PubMed]
  • Löw I, Grützmacher P, Bergmann M, Schoeppe W. Echocardiographic findings in patients on maintenance hemodialysis substituted with recombinant human erythropoietin. Clin Nephrol. 1989 Jan;31(1):26–30. [PubMed]
  • Verbeelen D, Bossuyt A, Smitz J, Herman A, Dratwa M, Jonckheer MH. Hemodynamics of patients with renal failure treated with recombinant human erythropoietin. Clin Nephrol. 1989 Jan;31(1):6–11. [PubMed]
  • Cropp GJ. Hemodynamic responses to oxygen breathing in children with severe anemia. Circulation. 1969 Oct;40(4):493–500. [PubMed]
  • Nonnast-Daniel B, Deschodt G, Brunkhorst R, Creutzig A, Bahlmann J, Shaldon S, Koch KM. Long-term effects of treatment with recombinant human erythropoietin on haemodynamics and tissue oxygenation in patients with renal anaemia. Nephrol Dial Transplant. 1990;5(6):444–448. [PubMed]
  • BROD J, FENCL V, HEJL Z, JIRKA J, ULRYCH M. General and regional haemodynamic pattern underlying essential hypertension. Clin Sci. 1962 Oct;23:339–349. [PubMed]
  • LEDINGHAM JM, COHEN RD. Circulatory changes during the reversal of experimental hypertension. Clin Sci. 1962 Feb;22:69–77. [PubMed]
  • Edmunds ME, Walls J, Tucker B, Baker LR, Tomson CR, Ward M, Cunningham J, Moore R, Winearls CG. Seizures in haemodialysis patients treated with recombinant human erythropoietin. Nephrol Dial Transplant. 1989;4(12):1065–1069. [PubMed]

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