Cardiovascular Indications and Complications of Recombinant Human Erythropoietin

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. by the use of recombinant human erythropoietin (rHuEPO) has been proven to be an effective treatment with several beneficial effects on exercise capacity due to reduction of hypoxia and improvement of cardiac function.[2] At present, rHuEPO is approved also for treatment of anemia caused by other conditions, including anemia-associated with renal failure, chemotherapy and HIV antiviral treatment or to reduce the need for transfusion in preoperative surgical patients. However, beside these beneficial effects, potential risk factors of a rHuEPO treatment have been reported. Treatment with rHuEPO has been linked to an increased risk of thrombotic events, and EPO seems to affect various cardiovascular and hemostatic parameters unrelated to increase in hematocrit.[3] Thus, as the potential uses of EPO therapy increases, it is important to reconsider its cardiovascular effects. Biology of erythropoietin EPO is synthesized by peritubular cells in the cortex-medullary border of the kidney[4] and in the liver during fetal and neonatal development.[5]A variety of other tissues have been reported to express EPO including bone marrow macrophages,[6] trophoblasts,[7] breast glands,[8] and astrocytes[9]. Access this article online Website: www.sysrevpharm.org Quick Response Code: DOI: 10.4103/0975-8453.83438