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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

18 anemic patients undergoing maintenance hemodialysis were treated with recombinant human erythropoietin (EPO) 1-3 times per week for 10.7 +/- 3 months. 4 patients underwent renal transplantation whereas 14 patients could be followed up during 12 months of EPO treatment. Hemoglobin concentration rose (from 7.0 +/- 0.7 to 11.0 +/- 1.1 g/dl, p less than 0.001) with an EPO maintenance dose of 298 units/kg/week. Blood transfusions were totally eliminated. 12 patients without iron overload required iron supplements. In the course of an infectious episode and notwithstanding an increase in EPO dosage, 2 patients exhibited a fall in hemoglobin which rose again after successful treatment of the infection. The few complications observed in connection with the rise in hemoglobin were: 1. deterioration of arterial hypertension in 7/18 with hypertensive encephalopathy in 3 patients, 2. thrombotic occlusion of the vascular hemodialysis access (a-v fistula) in 3/18, 3. periarticular inflammation with calcified deposits due to an elevated calcium-phosphorus product of 6.8 mmol/l in 4/18, 4. occurrence of hyperkalemia (6.9 +/- 0.3 mmol/l) in 7/18. These complications were more frequent during the first 3 months. They were corrected with close monitoring, drug therapy for hypertension, and intensification of dialysis and of treatment with phosphate binding substances, with the result that no differences were found in 14 patients before and after 12 months of treatment with EPO (blood pressure 133 +/- 25/77 +/- 9 vs 139 +/- 26/79 +/- 13 mm Hg [ns], potassium 5.4 +/- 0.4 vs 5.6 +/- 1.0 mmol/l [ns] and calcium-phosphorus product 4.3 +/- 1.0 vs 4.6 +/- 1.3 [ns]).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Treatment of anemia in hemodialysis patients using recombinant human erythropoietin: advantages and disadvantages]. 271 Nov 61

Anemia is an almost invariable feature of chronic renal failure and is particularly severe in children treated by long-term hemodialysis. Recombinant human erythropoietin (rhEPO) offers entirely new aspects in the treatment of renal anemia. This report presents three patients on maintenance hemodialysis aged 10, 10/10 12, and 18 years who were treated with rhEPO. Two suffered from hemochromatosis secondary to multiple transfusions. 100 U/kg rhEPO were administered three times weekly, and venesection after dialysis was performed when a target hematocrit value of 30% was achieved. Hematocrit, reticulocyte-counts and hemoglobin rose within 3 to 6 weeks after initiation of therapy in all patients. Serumferritin levels declined significantly in the two patients with hemochromatosis. No deterioration of the metabolic status (i.e. increase of blood urea nitrogen, serum-creatinine, -phosphate or -potassium) could be detected. Therapy had to be discontinued in one patient who experienced hypertensive ceisis. This patient, however, had suffered from severe hypertension prior to rhEPO therapy. Blood pressure remained stable in the other patients. We conclude that renal anemia can be effectively treated by rhEPO in children. Increase of blood pressure may necessitate discontinuation of therapy especially in primary hypertensive patients. Extensive studies are necessary to eluciate long-term effects of rhEPO in children.
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PMID:[Treatment of renal anemia with recombinant human erythropoietin]. 271 49

To investigate the mechanism of blood pressure upward after recombinant human erythropoietin (EPO) administration in patient with chronic renal failure (CRF), hemodynamic changes following on the improvement of anemia was evaluated by the echocardiography. Fourteen (5 males, 9 females) normotensive patients with less than 23% of hematocrit (HT) were administered 1,500 approximately 3,000 units of EPO three times a week. Four patients with systolic (greater than 160 mmHg) or diastolic (greater than 90 mmHg) hypertension after EPO administration was named group H, the remaining patients was named group N. Blood pressure, heart rates and parameters of echocardiography examined after the improvement of anemia were compared to those examined before EPO administration, respectively. Patients had an increase in Ht from 20.0 +/- 1.6% to 33.0 +/- 1.9% (p less than 0.01). LVDd, LVEDV, CO and flow velocity in group N were significantly decreased after EPO administration; while those in group H did not show the significant changes. IVSth and LVPWth in each group were significantly increased after EPO administration. These data showes that decrease in CO maintains the patients normotensive after EPO administration.
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PMID:[Effect of recombinant human erythropoietin administration on cardiovascular system in patient with chronic renal failure: an analysis of the blood pressure upward]. 273 9

To examine the effects of erythropoietin on the anemia of chronic renal disease and on the rate of renal deterioration, we administered recombinant human erythropoietin to 17 patients with anemia and progressive renal failure who did not yet require dialysis (serum creatinine level, 353 to 972 mumol per liter [4.0 to 11.0 mg per deciliter]). The dose of erythropoietin (50 to 150 units per kilogram of body weight) was adjusted according to the hematocrit response. In all 17 patients the anemia responded to erythropoietin. The median hematocrit increased from 0.27 to 0.37. The rate of the response depended on the initial erythropoietin dose and was similar to that observed in patients who were on dialysis. Hypertension was present in 14 patients before therapy, developed during therapy in 2 of the normotensive patients, and worsened in 9 patients, who required additional antihypertensive medications. The rate of the decline in renal function, as measured by serial determination of the reciprocal of the serum creatinine level, did not change significantly as the hematocrit rose (P = 0.78 by the paired t-test) during erythropoietin therapy. All the patients reported improvements in appetite, activity level, and sense of well-being. We conclude that erythropoietin therapy is effective in correcting the anemia of patients with progressive renal failure without affecting renal function, although it may be associated with an increase in blood pressure.
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PMID:Treatment of the anemia of progressive renal failure with recombinant human erythropoietin. 274 47

The quality of life was assessed in 37 maintenance hemodialysis patients during treatment with recombinant human erythropoietin (r-HuEPO; EPOGEN [epoetin alfa], AMGEN Inc, Thousand Oaks, CA) for correction of anemia. All patients experienced an increase in hematocrit level. The mean hematocrit level in the study population was 19.8% before therapy and 31.5% after therapy. Eighty-four percent of patients reported an increase in their sense of well-being. Better appetite was subjectively noted by 81% of patients. Improvements in sexual function (62%), socializing (70%), sleep (68%), and skin color (51%) were also noted. An increase in exercise capacity was reported by 78% of patients; objective measurements showed that the mean value of VO2max in a subgroup of 11 patients increased by 50% after treatment. The Karnofsky score calculated in 29 patients showed improvement in all patients except those aged greater than 70 years. The group mean Karnofsky score increased from 76 before to 86.6 after therapy, indicating that with r-HuEPO treatment subjects were able to exert themselves to perform ordinary activities. Before therapy 14 of the patients were unemployed; after therapy only two did not work. Those side effects that occurred, predominantly iron deficiencies, hypertension, and hyperkalemia, were controlled by appropriate clinical management. Treatment with r-HuEPO does improve the quality of life and ability to work of uremic patients and does not adversely affect their transplant potential.
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PMID:Improvements in quality of life following treatment with r-HuEPO in anemic hemodialysis patients. 275 25

Inhibitors of erythropoiesis found in the blood of uremic patients have been implicated as some of the causes of anemia in chronic renal failure. As a treatment to remove the inhibitors, continuous ambulatory peritoneal dialysis (CAPD) is thought to be more effective than hemodialysis. Some researchers have reported that CAPD has improved anemic state in hemodialysis patients. However, there have been some cases of severe anemia seen in CAPD patients. To access the effect of the CAPD, we have performed serial examination on hemoglobin (Hb) and hematocrit (Ht) in 5 uremic patients under CAPD treatment. Hb levels in 4 and Ht in 3 of 5 patients have been known to be increased. One patient was shown to have no increment on the levels of Hb and Ht. On the other hand, further investigation has been down to access the effect of the recombinant human erythropoietin (r-HuEPO: Chugai pharmaceutical) on anemic patients, in whom no effect was noticed by treatment of CAPD. One severe anemic patient, who had been undergoing the treatment of CAPD for two years, was given r-HuEPO intravenously. The patient showed the increment on the levels of Hb and Ht, and the decreases on the levels of serum iron and ferritin. However, the patient has developed hypertension. In conclusion, CAPD was known to be not always effective for the increment of Hb and Ht, while r-HuEPO was very effective for the improvement of severe anemia in CAPD patients which enabls them to lead better social life for them.
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PMID:[Anemia in patients on continuous ambulatory peritoneal dialysis (CAPD)]. 280 27

Recombinant human erythropoietin is a major advance in the management of patients with chronic renal failure. The sustained dose-dependent rise in haematocrit which it produces effectively abolishes symptoms of anaemia, but at the cost of an increase in blood viscosity. This in turn predisposes to increased vascular resistance and the development of hypertension. Over half of all deaths of patients with end-stage renal failure are from cardiovascular disease, notably myocardial infarction, heart failure, and stroke, for which hypertension is a known risk factor. Erythropoietin-related increases in blood pressure are therefore of particular concern, and seem to be most severe in previously hypertensive patients. There is now a need to establish the optimum rate and extent of rise of haematocrit required to alleviate symptoms without incurring undue risk.
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PMID:Hypertension, blood viscosity, and cardiovascular morbidity in renal failure: implications of erythropoietin therapy. 289 90

Recombinant human erythropoietin (r-HuEPO) has been used for the treatment of renal anaemia in haemodialysed patients for more than 2 years. The recommended initial dose is 50 U/kg, intravenously, three times a week, subsequent to the dialysis procedure; if the increase in the haemoglobin level were insufficient after the 4-week therapy, the single doses should be elevated in steps of 25 U/kg each. A weekly total dose of about 200 U/kg (divided into 2 or 3 applications) will normally be adequate to stabilize the haemoglobin value at a level ranging between 10 and 12 g/dl. Patients on r-HuEPO require regular medical supervision, as--along with increasing haematocrit--hypertension and thrombosis of the arteriovenous fistula can develop. A slight increase in serum creatinine and potassium was observed in some of the studies.
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PMID:Treatment of anaemia in haemodialysis patients with recombinant erythropoietin. 291 79

Five anemic, transfusion-dependent patients aged 12 to 18 years, who had end-stage renal disease (mean hematocrit value 22 +/- 0.31%) and were on a regimen of peritoneal dialysis, were treated with recombinant human erythropoietin (rHuEpo), which was self-administered at home by subcutaneous injections thrice weekly at an initial dosage of 150 U/kg. All patients had an increase in the reticulocyte count and hemoglobin concentration, and none required further transfusions. The hematocrit level rose to a mean of 33.04 +/- 1.86% within 3 weeks of rHuEpo therapy, and the dosage was adjusted to keep the hematocrit level between 32% and 38% indefinitely. Currently four of these patients require only one dose a week to sustain the hematocrit level. No antibodies to the rHuEpo were formed. Three patients had an exacerbation of hypertension, which required an adjustment in antihypertensive therapy. No other side effects were noted. The results demonstrate that rHuEpo is effective in correcting the anemia of end-stage renal disease, thereby eliminating the associated clinical symptoms and the need for further blood transfusions.
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PMID:Use of subcutaneous recombinant human erythropoietin in children undergoing continuous cycling peritoneal dialysis. 292 67

Recombinant human erythropoietin (rhEpo) has been demonstrated in several studies to be effective in correcting the anemia of regular dialysis patients. This was accompanied by a significant improvement of the physical work capacity shown by exercise testing. The main side effect of rhEpo treatment has been the development or aggravation of hypertension in approximately 30% of the treated patients. In 2% hypertensive encephalopathy and convulsions occurred. Data obtained by measurements of regional blood flow indicate the peripheral resistance did increase probably due to rise of blood viscosity and reversal of preexisting hypoxic vasodilatation. To avoid hypertensive complications anemia should be corrected slowly over a period of 12-16 weeks. Target hematocrit should not exceed 30-35 vol. %. Blood pressure and volume status should be monitored closely.
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PMID:[Erythropoietin and hypertension]. 305 76


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