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Review Article

SRP. 2011; 2(1): 43-47

Cardiovascular Indications and Complications of Recombinant Human Erythropoietin

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 effects further studies are needed to define the
role of rHuEPO in chronic cardiovascular settings.

Key words: Cardiovascular mortality CHOIR study Chronic kidney disease Recombinant human erythropoietin

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