Is hypertension a determinant of erythropoietin requirements in hemodialysis?

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Glennie, Judith Lynn
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Statement of problem. Post-hoc analysis of results from a pilot study of erythropoietin (Epo) use in hemodialysis (HD) suggested that, to achieve a target hemaglobin (Hg) level, higher doses of Epo were required in patients with hypertension (HTN). There was a need to clarify the role of HTN in determining Epo responsiveness, which led to the hypothesis that the presence of HTN predicts the need for higher Epo doses to achieve a target Hg. Methods. The study retrospectively reviewed HD patients treated with Epo using an observational, descriptive study design. Data for a single therapeutic inception cohort were collected from the first 4 to 6 months (4-6m) of uninterrupted Epo administration. Parametric methods were used to analyze the data to determine whether the postulated relationship between HTN and Epo requirements existed, as well as the impact of other intervening factors. Results. The final cohort consisted of 111 patients whose data revealed no relationship between Epo dose and any of the many measures of HTN collected in this study. Multiple regression and other parametric methods consistently pointed to the role of angiotensin-converting enzyme inhibitor (ACEI) use as a predictor of the 4-6m Epo requirement. The data demonstrated that patients receiving ACEI therapy received less Epo and, independently, achieved lower 4-6m Hg levels. Postulated mechanisms for this phenomenon are discussed. Conclusions. While HTN does not appear to influence Epo dosing requirements, patients receiving ACEIs for the treatment of HTN may require a modified approach to therapy to achieve the full benefits of Epo in a cost-effective manner.