PS 08-53 HYPERTENSION AND ENDOTHELIAL DYSFUNCTION IN HEMODIALYSIS PATIENTS TREATED WITH ERYTHROPOIETIN

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Abstract

Objective:

Hemodialysis patient's hypertension involves volume overload, stimulation of the renin-angiotensin system, activation of the sympathetic nervous system, electrolyte changes and antihypertensive drug elimination through the dialyzer. Treatment with erythropoietin (EPO) is accompanied by increased peripheral vascular resistance by increasing the hematocrit, increased plasma levels of endothelin and decreased nitric oxide synthesis.

Design and Method:

We have studied 96 patients on hemodialysis. Gathering weekly dose of erythropoietin administered in hemodialysis, hypertension treatment, age, sex, hematocrit, diabetes. In 20 patients were measured for caliber, blood velocity, blood flow, by Doppler US in the brachial artery and shear rate and was considered as the dependent variable. We used R for statistical analysis. Univariate analysis was performed by Chi2 test and multivariate analysis was performed using logistic regression.

Results:

For 96 patients (61 were men, 35 women), mean age 59.2 years. 24% had diabetes, 40% were taking statins. 19 patients were not taking antihypertensive medication. 60 patients were taking ACE inhibitors or ARB; 13 patients, beta-blockers; 4 patient, calcium channel blocker. 91 of 96 taking antiplatelet agents. Association between treatment with low doses of EPO and not taking anti- hypertensive medication was found (Chi2 = 4.282, p < 0.039) by a factor of risk of not taking anti-hipertesive drugs as 2.3 for the cohort of patients treated with a dose of EPO < 9000 U / week. Association was found between low weekly dose of EPO and low value of shear rate (Chi2 = 6.408, p < 0.01) by a factor of risk for low value of shear rate as 3.15 for the cohort that received treatment with EPO <9000 U / week. In multivariate analysis, patients not taking antihypertensive medication had lower values of shear rate (p < 0.01).

Conclusions:

The lower erythropoietin dose to 9000 U / week is associated with better control of hypertension, and low levels of shear stress

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