engleski

The effect of different erythropoiesis-stimulating agent type to the incidence of arterial hypertension in euvolemic maintenance hemodialysis patients

Objective. Arterial hypertension (AH) is an adverse effect of erythropoiesis-stimulating agent (ESA) treatment among hemodialysis (HD) patients. Among several mechanisms considered in the pathogenesis of ESA-induced hypertension are rise of hematocrit and erythrocyte mass and direct vasopressor action of ESA. The aim of this study was to determine the effect of different ESA type to the incidence of AH among euvolemic HD patients. Design and methods. We included all prevalent HD patients from the Department of Nephrology, Dialysis and Kidney Transplantation, Clinical Hospital Centre Rijeka, from January 1, 2014, to December 31, 2015, allocated into four groups – those without ESA, and those with short, medium and long acting ESA, observing weekly dosage in I.U. Every six months, before starting the midweek HD session, multifrequency bioimpedance analysis (MF-BIA) was performed together with serum albumine and hemoglobine levels. Blood pressure (BP) and mean arterial pressure (MAP) were assessed before and at the end of HD treatment. Patients with volume-dependent AH based on MF-BIA assessement (>2.5 litres overhydration) and not reaching two or more measurements were excluded. Results. A number of 350 measurements were eligible for statistical analysis, made on 153 patients (age 69.1±13.8, range 23-92 yrs, 56% male, 25% diabetic, HD duration 61.34±74.61 months). There was no statistically significant difference between the groups at the baseline. Mean weekly ESA dose was 6998.16 ± 4856.86 I.U. In comparison to non-ESA group (25% measurments) ; short, medium and long acting ESA showed statistically significant higher incidence of AH (42%, p=0, 03 ; 50%, p=0.002 ; and 43%, p=0, 018, respectively) with highest incidence at medium and long acting ESA (p=0, 016). Both BP and MAP before and after HD session strongly correlated with ESA dose but not with serum albumin and hemoglobin levels. Conclusions. Our study showed that all three types of ESA increased the incidence of AH in euvolemic HD patients, with highest incidence related to medium and long acting ESA. Systolic and dyastolic BP and MAP correlated with weekly ESA dose while serum hemoglobine and albumin levels showed no correlation with BP. Further investigations in greater number of patients are needed.

erythropoiesis stimulating agent ; hypertension ; hemodialysis

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