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Cited by 97Erythropoietin and Anemia TreatmentDialysis and Renal Disease ManagementIron Metabolism and Disorders

Anaemia, rHuEPO resistance, and cardiovascular disease in end-stage renal failure; links to inflammation and oxidative stress

Stenvinkel, P.·2002·Nephrology Dialysis Transplantation
DOI 10.1093/ndt/17.suppl_5.32
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Abstract

End-stage renal disease (ESRD) is characterized by a high mortality rate, derived largely from cardiovascular disease (CVD). In patients with ESRD, high levels of pro-inflammatory cytokines and increased oxidative stress are common features that may contribute to malnutrition, anaemia, recombinant human erythropoietin (rHuEPO) resistance, and atherosclerosis. Inflammation predicts poor outcome in ESRD. It is multifactorial in cause and, while it may reflect the underlying CVD, the acute-phase response may also contribute to both oxidative stress and progressive vascular injury. In patients with ESRD, the acute-phase response may be influenced by a number of factors unrelated to dialysis and perhaps by the dialysis procedure itself. Inflammation and the acute-phase response interact with the haematopoietic system at several levels resulting in reduced erythropoiesis, accelerated destruction of erythrocytes, and blunting of the reactive increase in erythropoietin in response to reduced haemoglobin levels. In patients with ESRD, rHuEPO resistance has been linked with inflammation, the latter of which is often associated with a state of functional iron deficiency. Patients with ESRD are thought to have a reduced capacity to handle oxidative stress. There is recent evidence that a relationship may exist between inflammation and oxidative stress and treatment of anaemia with rHuEPO. However, iron may also generate oxidative stress. Controlled trials are needed before evidence-based recommendations for the management of inflammation-induced anaemia and resistance to rHuEPO can be defined.

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  • There is accumulating evidence that anemia is related to a series of severe complications in CVD such as thromboembolic events, bleeding complications, uncontrolled hypertension, more frequent supraventricular and ventricular arrhythmias, and inflammation characterized by elevated levels of inflammatory cytokines.

    “There is accumulating evidence that anemia is related to a series of severe complications in CVD such as thromboembolic events (e.g., venous thrombosis and stroke), bleeding complications (191), uncontrolled hypertension (117), more frequent supraventricular and ventricular arrhythmias, and inflammation characterized by elevated levels of inflammatory cytokines (170).”

    From Red Blood Cell Function and Dysfunction: Redox Regulation, Nitric Oxide Metabolism, Anemia (2017) · cites this paper as [170]

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Research works printed but not linked: 2

  1. Churchill DN, Taylor DW, Cook RJ et al. Canadian hemo- dialysis morbidity study. Am J Kidney Dis 1992; 19: 214-234
  2. Rigatto C, Parfrey P, Foley R, Negrijn C, Tribula C, Jeffery J. Congestive heart failure in renal transplant recipients: risk factors, outcomes, and relationship with ischemic heart disease. J Am Soc Nephrol 2002; 13: 1084-1090

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Authors
Stenvinkel, P.
Affiliations
Karolinska Institutet (SE)
Corresponding author
Stenvinkel, P.
ORCID
Stenvinkel, P.
Venue
Nephrology Dialysis Transplantation
Publisher
Oxford University Press (OUP)
Published
2002-05-01
Volume
17
Issue
90005
Pages
32-37
ISSN
  • 0931-0509 (ISSN-L)
  • 1460-2385
DOI
10.1093/ndt/17.suppl_5.32
OpenAlex
W2136748937
Cited by
97
References
84
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2020: 4 · 2019: 1 · 2018: 3 · 2016: 4 · 2015: 3 · 2014: 9 · 2013: 1 · 2012: 3
FWCI
3.22
Type
journal article
Language
en
Open access
closed
Locations
  • Nephrology Dialysis Transplantation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
Keywords
end-stage renal disease, anemia of chronic kidney disease, cardiovascular disease, inflammation, oxidative stress, acute phase response, inflammatory cytokines, functional iron deficiency, erythropoiesis, atherosclerosis, dialysis, malnutrition
MeSH terms
Anemia, Cardiovascular Diseases, Drug Resistance, Erythropoietin, Humans, Inflammation, Kidney Failure, Chronic, Recombinant Proteins, Cytokines, Treatment Failure, Oxidative Stress

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