Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury

Introduction: Erythropoiesis stimulating agents (ESA) correction of renal anemia increases blood pressure in as many as 35% of patients. It is uncertain whether this phenomenon is due to ESA-induced vasoconstriction and/or increased red blood cell mass. The Early Intervention in Acute Renal Failur...

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Main Authors:	Endre, Zoltan H., Md Ralib, Azrina, Pickering, John W., Major, Tamas, Goodkin, David A., Palmer, Suetonia
Format:	Article
Language:	English
Published:	American Society of Nephrology. 2011
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/37393/ http://irep.iium.edu.my/37393/ http://irep.iium.edu.my/37393/1/8._ASN_2011_EPO.pdf

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spelling	iium-373932014-08-11T07:10:19Z http://irep.iium.edu.my/37393/ Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury Endre, Zoltan H. Md Ralib, Azrina Pickering, John W. Major, Tamas Goodkin, David A. Palmer, Suetonia R Medicine (General) Introduction: Erythropoiesis stimulating agents (ESA) correction of renal anemia increases blood pressure in as many as 35% of patients. It is uncertain whether this phenomenon is due to ESA-induced vasoconstriction and/or increased red blood cell mass. The Early Intervention in Acute Renal Failure (EARLYARF) trial4 provided an opportunity to assess whether intravenous (IV) epoetin induces immediate vasoconstriction. Method: A post-hoc analysis of 160 of 163 patients randomized to receive two doses 24 hours apart of IV epoetin (500 U/kg) or placebo. These intensive-care patients were enrolled following identification of acute kidney injury (AKI) by the urinary biomarkers γ-glutamyltranspeptidase and alkaline phosphatase. Hourly mean arterial pressures (MAP), and norepinephrine equivalent dose (NED: determined using equipotency conversion factors for doses of epinephrine, vasopressin, phenylephrine, or dopamine), and hemoglobin (Hb) and hematocrit (Hct) were extracted from clinical records. The differences between maximum and baseline MAP and NED (ΔMAP and ΔNED) were determined at 4, 24, and 72 hours, and Hb and Hct at 7, and 30-day after study drug administration. Result: At baseline, MAP was 78±14 mmHg in the epoetin group and 81±15 mmHg in the placebo group (p=0.22). There were no differences between groups in ΔMAP, ΔNED or ΔMAP adjusted for ΔNED at 4-h after the first and second drug dose (Table 1). Similarly, there were no differences within 24 hours (Figure 1), or at any other time points. Hemoglobin concentration and hematocrit were unchanged. A subgroup analysis of patients with no vasopressor use (n=71) also showed no differences between epoetin and placebo for all outcomes. Conclusion: Parenteral high dose epoetin administration did not acutely increase blood pressure in critically ill individuals at risk of acute kidney injury, suggesting epoetin did not induce acute vasoconstriction. American Society of Nephrology. 2011 Article PeerReviewed application/pdf en http://irep.iium.edu.my/37393/1/8._ASN_2011_EPO.pdf Endre, Zoltan H. and Md Ralib, Azrina and Pickering, John W. and Major, Tamas and Goodkin, David A. and Palmer, Suetonia (2011) Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury. Journal of the American Society of Nephrology, 22. 296A-297A. ISSN 1533-3450 (O), 1046-6673 (P) http://jasn.asnjournals.org/content/by/year/2011
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Endre, Zoltan H. Md Ralib, Azrina Pickering, John W. Major, Tamas Goodkin, David A. Palmer, Suetonia Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury
description	Introduction: Erythropoiesis stimulating agents (ESA) correction of renal anemia increases blood pressure in as many as 35% of patients. It is uncertain whether this phenomenon is due to ESA-induced vasoconstriction and/or increased red blood cell mass. The Early Intervention in Acute Renal Failure (EARLYARF) trial4 provided an opportunity to assess whether intravenous (IV) epoetin induces immediate vasoconstriction. Method: A post-hoc analysis of 160 of 163 patients randomized to receive two doses 24 hours apart of IV epoetin (500 U/kg) or placebo. These intensive-care patients were enrolled following identification of acute kidney injury (AKI) by the urinary biomarkers γ-glutamyltranspeptidase and alkaline phosphatase. Hourly mean arterial pressures (MAP), and norepinephrine equivalent dose (NED: determined using equipotency conversion factors for doses of epinephrine, vasopressin, phenylephrine, or dopamine), and hemoglobin (Hb) and hematocrit (Hct) were extracted from clinical records. The differences between maximum and baseline MAP and NED (ΔMAP and ΔNED) were determined at 4, 24, and 72 hours, and Hb and Hct at 7, and 30-day after study drug administration. Result: At baseline, MAP was 78±14 mmHg in the epoetin group and 81±15 mmHg in the placebo group (p=0.22). There were no differences between groups in ΔMAP, ΔNED or ΔMAP adjusted for ΔNED at 4-h after the first and second drug dose (Table 1). Similarly, there were no differences within 24 hours (Figure 1), or at any other time points. Hemoglobin concentration and hematocrit were unchanged. A subgroup analysis of patients with no vasopressor use (n=71) also showed no differences between epoetin and placebo for all outcomes. Conclusion: Parenteral high dose epoetin administration did not acutely increase blood pressure in critically ill individuals at risk of acute kidney injury, suggesting epoetin did not induce acute vasoconstriction.
format	Article
author	Endre, Zoltan H. Md Ralib, Azrina Pickering, John W. Major, Tamas Goodkin, David A. Palmer, Suetonia
author_facet	Endre, Zoltan H. Md Ralib, Azrina Pickering, John W. Major, Tamas Goodkin, David A. Palmer, Suetonia
author_sort	Endre, Zoltan H.
title	Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury
title_short	Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury
title_full	Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury
title_fullStr	Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury
title_full_unstemmed	Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury
title_sort	acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury
publisher	American Society of Nephrology.
publishDate	2011
url	http://irep.iium.edu.my/37393/ http://irep.iium.edu.my/37393/ http://irep.iium.edu.my/37393/1/8._ASN_2011_EPO.pdf
first_indexed	2023-09-18T20:53:39Z
last_indexed	2023-09-18T20:53:39Z
_version_	1777410160592945152

Acute high-dose intravenous epoetin did not increase blood pressure in critically ill patients with acute kidney injury

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