Сердечно-сосудистые последствия почечной анемии и терапия эритропоэтином
Аннотация
История болезни 1 Больной 37 лет. В возрасте 30 лет впервые была диагностирована хроническая почечная недостаточность (ХПН). Биопсия почки не производилась. 7 лет спустя развилась терминальная ХПН (ТХПН), и был начат программный гемодиализ (ГД) в режиме 3 раза в неделю. До начала ГД имела место умеренная артериальная гипертония. После начала диализной терапии она уменьшилась и далее хорошо контролировалась малыми дозами метопролола. Гемоглобин крови (Нb) к началу ГД составлял 7-7,5 г/дл, в связи с чем через 4 мес. после начала диализа была начата терапия рекомбинантным эритропоэтином (Эпо). В результате уровень Нb быстро повысился до 10 г/дл и затем постепенно нормализовался. Доза Эпо составляет в настоящее время 6000 МЕ в неделю. Пациент часто путешествует, получая ГД в других диализных центрах. Во время путешествий Эпо-терапия, как правило, прерывается, ибо, по мнению большинства врачей этих центров, целевой Нb должен быть более низким. Как следствие, уровень Нb у пациента значительно и необычным образом варьирует. Сам пациент отмечает, что при снижении Нb ниже 12 г/дл его трудоспособность и физическая активность снижаются, становясь субоптимальными. Тем не менее, он вполне трудоспособен, и будучи кандидатом наук и занимаясь интеллектуальной деятельностью, работает полный рабочий день. Ангинозные приступы и одышка его не беспокоят. По данным эхокардиограммы, выполненной через 7 лет после начала ГД, размеры левого желудочка, толщина перегородки и задней стенки левого желудочка не изменены, дисфункция миокарда отсутствует. ** Публикуется по согласованию с автором и с разрешения Oxford University Press. ** Перевод Н.А. Томилиной, А.С. Бирюковой
Об авторе
Екард Кай-Уве
Отделение нефрологии и интенсивной медицины, Шарите, Университет Гумбольдта, Берлин, Германия
Россия
Россия
Список литературы
1. Pastan S., Bailey J. Dialysis therapy. N Engi J Med 1998; 338: 1428-1437.
2. Mall G., Rambausek M., Neumeister A. et al. Myocardial interstitial fibrosis in experimental uremia-implications for cardiac compliance. Kidney Int 1988; 33: 804-811.
3. Mall G., Huther W., Schneider J. et al. Diffuse intermyocardiocytic fibrosis in uraemic patients. Nephrol Dial Transplant 1990; 5: 39-44.
4. Ikram H., Lynn K.L., Bailey R.R. et al. Cardiovascular changes in chronic hemodialysis patients. Kidney Int 1983; 24: 371-376.
5. Rostand S.G., Kirk K.A., Rutsky E.A. Dialysis-associated ischemic heart disease: Insights from coronary angiography. Kidney Int 1984; 25: 653-659.
6. Amann К., Wiest G., Zimmer G. et al. Reduced capillary density in the myocardium of uremic rats-a stereological study. Kidney Int 1992; 42: 1079-1085.
7. Raine A.E.G., Seymour A.-M.L., Roberts A.F.C. et al. Impairment of cardiac function and energetics in experimental renal failure. J Clin Invest 1993; 92: 2934-2940.
8. Foley R.N., Parfrey P.S., Harnett J.D. et al. Clinical and echocardio-graphic disease in patients starting end-stage renal disease therapy. Kidney Int 1995; 47: 186-192.
9. Greaves S.C., Gamble G.D., Collins J.F. et al. Determinants of left ventricular hypertrophy and systolic dysfunction in chronic renal failure. Am J Kid Dis 1994; 24: 768-776.
10. Parfrey P.S., Foley R.N., Harnett J.D. et al. Outcome and risk factors for left ventricular disorders in chronic uremia. Nephrol Dial Transplant 1996; 11: 1277-1285.
11. Silberberg J.S., Barre Р.Е., Prichard S.S. et al. Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney Int 1988; 36: 286-290.
12. Herzog C.A., Ma J.Z., Collins A.J. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engi J Med 1998; 339: 799-805.
13. Renal Data System. USRDS 1997 annual data report Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases 1997; D1-D51.
14. Neill W.A., Oxendine J.M., Moore S.C. Acute and chronic cardiovascular adjustments to induced anemia in dogs. Am J Physiol 1969; 217: 710-714.
15. Schwartz S., Frantz R.A., Shoemaker W.C. Sequential hemodynamic and oxygen transport responses in hypovolemia, anemia, and hypoxia. Am J Physiol 1981; 241: H864-H871.
16. Roy S.B., Bhatia M.L., Mathur V.S. et al. Hemodynamic effects of chronic severe anemia. Circulation 1963; 28: 346-356.
17. Duke M., Abelmann W.H. The hemodynamic response to chronic anemia. Circulation 1969; 39: 503-515.
18. Olivetti G., Quaini F., Lagrasta С. et al. Myocyte cellular hypertrophy and hyperplasia contribute to ventricular wall remodeling in anemia-induced cardiac hypertrophy in rats. Am J Pathol 1992; 141: 227-239.
19. London G.M., Fabiani F., Marchais S.J. et al. Uremic cardiomyopathy: an inadequate left ventricular hypertrophy. Kidney Int 1987; 31: 973-980.
20. Levin A., Singer J., Thompson C.R. et al. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kid Dis 1996; 27: 347-354.
21. Foley R.N., Parfrey P.S., Harnett J.D. et al. The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. Am J Kid Dis 1996; 28: 53-61.
22. Madore F., Lowrie E.G., Brugnara С. et al. Anemia in hemodialysis patients: variables affecting this outcome predictor. JASN 1997; 8: 1921-1929.
23. Wizemann V., Kaufmann J., Kramer W. Effect of erythropoietin on ischemia tolerance in anemic hemodialysis patients with confirmed coronary artery disease. Nephron 1992; 62: 161-165.
24. Macdougall L.С., Lewis N.P., Saunders M.J. et al. Long-term cardiorespiratory effects of amelioration of renal anemia by erythropoietin. Lancet 1990; 335: 489-493.
25. Neff M.S., Kwan E.K., Persoff M. et al. Hemodynamics of uremic anemia. Circulation 1971; 43: 876-883.
26. Sikole A., Polenakovic M., Spirovska V. et al. Analysis of heart morphology and function following erythropoietin treatment of anemic dialysis patients. Artif Organs 1993; 17: 977-984.
27. Low-Friedrich I., Grtltzmacher P., Marz W. et al. Therapy with recombinant human erythropoietin reduces cardiac size and improves heart function in chronic hemodialysis patients. Am J Nephrol 1991; 11: 54-60.
28. Cannella G., LaCanna G., Sandrini M. et al. Renormalization of high cardiac output and of left ventricular size following long-term recombinant human erythropoietin treatment of anemic dialyzed uremic patients. Clin Nephrol 1990; 34: 272-282.
29. London G.M., Zins В., Pannier В. et al. Vascular changes in hemodialysis patients in response to reombinant human erythropoietin. Kidney Int 1989; 36: 878-882.
30. Low I., Grutzmacher P., Bergmann M. et al. Echocardiographic. findings in patients on maintenance hemodialysis substituted with recombinant human erythropoietin. Clin Nephrol 1988; 31: 26-30.
31. Martinez-Vea A., Bardaji A., Garcia С. et al. Long-term myocardial effects of correction of anemia with recombinant human erythropoietin in aged patients on hemodialysis. Am J Kid Dis 1992; 19: 353-357.
32. Fellner S.K., Lang R.M., Neumann A. et al. Cardiovascular consequences of correction of the anemia of renal failure with erythropoietin. Kidney Int 1993; 44: 1309-1315.
33. Wizemann V., Schafer R., Kramer W. Follow-up of cardiac changes induced by anemia compensation in normotensive hemodialysis patients with left-ventricular hypertrophy. Nephron 1993; 64: 202-206.
34. Silberberg J., Racine M., Barre P. et al. Regression of left ventricular hypertrophy in dialysis patients following correction of anemia with recombinant human erythropoietin. Can J Cardiol 1990; 6: 1-4.
35. Pernandez A., Vega N., Jimenez F. et al. Effect of recombinant human erythropoietin treatment on hemodynamic parameters in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am J Nephrol 1992; 12: 207-211.
36. Pascual J., Teruel J.L., Marcen R. et al. Hemodynamic and cardiac effects of erythropoietin in patients on regular dialysis. Int J Artif Organs 1992; 15: 349-353.
37. Zehnder С., Zuber M., Sulzer M. et al. Influence of long-term amelioration of anemia and blood pressure control on left ventricular hypertrophy in hemodialyzed patients. Nephron 1992; 61: 21-25.
38. Goldberg N., Lundin P., Delano В. et al. Changes in left ventricular size, wall thickness, and function in anemic patients treated with recombinant human erythropoietin. Am Heart J 1992;124: 424-427.
39. Pascual J., Teruel J.L., Moya J.L. et al. Regression of left ventricular hypertrophy after partial correction of anemia with erythropoietin in patients on hemodialysis: a prospective study. Clin Nephrol 1991; 35: 280-287.
40. Monrad E.S., Hess О.М., Murakami T. et al. Time course of regression of left ventricular hypertrophy after aortic valve replacement. Circulation 1988; 77: 1345-1355.
41. Cannella G., Paoletti E., Delfineo R. et al. Regression of left ventricular hypertrophy in hypertensive dialyzed uremic patients on long-term antihypertensive therapy. Kidney Int 1993; 44: 881-886.
42. Radermacher J., Koch K.M. Treatment of renal anemia by erythropoietin substitution-The effects on the cardiovascular system. Clin Nephrol 1995; 44: S56-S60.
43. Potoles J., Torralbo A., Martin P. et al. Cardiovascular effects of recombinant human erythropoietin in predialysis patients. Am J Kid Dis 1997; 29: 541-548.
44. Mann J.F.E. Hypertension and cardiovascular effects-long term safety and potential long-term benefits of r-HuEPO. Nephrol Dial Transplant 1995; 10: 80-84.
45. Raine A.E.G., Roger S.D. Effects of erythropoietin on blood pressure. Am J Kid Dis 1991; 18: 76-83.
46. Radermacher J., Koch K.M. Erythropoietin and Hypertension. In: Bauer C., Koch K.M., Scigalla P., Wieczorek L. eds. Erythropoietin-Molecular Physiology and Clinical Application. Marcel, Dekker, New York, Basel, Hong Kong: 1993; 129-150.
47. Touam M., Olivia J.P., Zingraff J. et al. Does intravenous erythropoietin lead to an immediate, transient increase in arterial blood pressure in dialysis patients? Nephron 1994; 67: 240-241.
48. Roger S.D., Grasty M.S., Baker L.R.I. et al. Effects of oxygen breathing and erythropoietin on hypoxic vasodilatation in uremic anemia. Kidney Int 1992; 42: 975-980.
49. Heidenreich S., Rahn K.-H., Zidek W. Direct vasopressor effect of recombinant human erythropoietin on renal resistance vessels. Kidney Int 1991; 39: 259-265.
50. Tsukada H., Ishimitsu Т., Ogawa Y. et al. Direct vasopressor effects of erythropoietin in genetically hypertensive rats. Life Sci 1993; 52: 1425-1434.
51. Carlini R.G., Dusso A.S., Obialo C.I. et al. Recombinant human erythropoietin (rHuEPO) increases endothelin-1 release by endo-thelial cells. Kidney Int 1993; 43: 1010-1014.
52. Neusser M., Tepel M., Zidek W. Erythropoietin increases cyto-solic free calcium concentration vH vascular smooth muscle cells. Cardiovasc Res 1993; 27: 1233-1236.
53. Katch К., Mizuno К., Hashimoto S. et al. Direct evidence for erythropoietin-induced release of endothelin from peripheral vascular tissue. Life Sci 1994; 54: PL253-PL259.
54. Gogusev J., Zhu D.-L., Herembert T. et al. Effect of erythropoietin on DNA synthesis, proto-oncogene expression and phospholipase С activity in rat vascular smooth muscle cells. Biochem Biophys Res Commun 1994; 199: 977-983.
55. Haller H., Christel С., Dannenberg L. et al. Signal transduction of erythropoietin in endothelial cells. Kidney Int 1996; 50: 481-488.
56. Nissenson A.R., Besarab A., Bolton W.K. et al. Target haematocrit during erythropoietin therapy. Nephrol Dial Transplant 1997; 12: 1813-1816.
57. Eschbach J.W., Egrie J.C., Downing M.R. et al. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. N Engi J Med 1987; 316: 73-78.
58. Eckardt K.-U. Erythropoietin: oxygen-dependent control of erythropoiesis and its failure in renal disease. Nephron 1994; 67: 7-23.
59. Canadian erythropoietin study group. Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving hemodialysis. Br Med J 1990; 300: 573-578.
60. Marrades R.M., Roca J., Campistol J.M. et al. Effects of erythropoietin on muscle O2 transport during exercise in patients with chronic renal failure. J Clin Invest 1996; 97: 2092-2100.
61. Moore G.E., Bertocci L.A., Painter P.L. 3 IP-magnetic resonance spectroscopy assessment of subnormal oxidative metabolism in skeletal muscle of renal failure patients. J Clin Invest 1993; 91: 420-424.
62. McMahon L.P., McKenna M.J., Sangkabutra T. et al. Physical performance and associated electrolyte changes after haemoglobin normalization: a comparative study in haemodialysis patients. Nephrol Dial Transplant 1999; in press.
63. Besarab A., Bolton K., Browne J.K. et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N En gi J Med 1998; 339: 584-590.
64. Macdougall I.С., Ritz E. The normal haematocrit trial in dialysis patients with cardiac disease: are we any the less confused about target haemoglobin? Nephrol Dial Transplant 1998; 13: 3030-3033.
Рецензия
Для цитирования:
Кай-Уве Е. Сердечно-сосудистые последствия почечной анемии и терапия эритропоэтином. Нефрология и диализ. 2000;2(3):181-188.
For citation:
Kai-Uwe E. Cardiovascular consequences of renal anaemia and erythropoietin therapy. Nephrology and Dialysis. 2000;2(3):181-188. (In Russ.)
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