Key result
Erythropoietin administration in ESRD patients resulted in no change in plasma renin activity in 9 studies and a decrease in 4 studies, with discrepant effects on aldosterone.
Why the study?
Does erythropoietin administration alter plasma renin activity and aldosterone levels in patients with chronic kidney disease and end-stage renal disease?
Does erythropoietin administration alter plasma renin activity and aldosterone levels in patients with chronic kidney disease and end-stage renal disease?
Available evidence indicates that erythropoietin administration does not consistently alter plasma renin activity or aldosterone levels in patients with CKD or ESRD.
Inconsistent effects on renin and aldosterone should not change practice; leaves open need for controlled trials in ESRD.
The effect of erythropoietin (EPO) administration on the responsiveness of the renin-angiotensin-aldosterone system (RAAS) has not been established. Because patients with chronic kidney disease (CKD) require EPO for their management as CKD progresses, it is important to ascertain whether EPO treatment alters the RAAS. If EPO administration stimulates renin-angiotensin or aldosterone (ALDO) this intervention would mediate cardiovascular and renal injury, and consequently promote cardiovascular events and/or exacerbate the progression of renal disease. We reviewed the available publications investigating the effects of EPO on the RAAS. In CKD patients following EPO administration plasma renin activity (PRA) was unchanged in all three and ALDO was not altered in the two studies in which it was determined. In end-stage renal disease (ESRD) patients undergoing dialysis following EPO administration, four studies reported a decrease in PRA levels whereas the remaining nine disclosed no change in PRA levels. The changes in ALDO levels after EPO administration in ESRD patients were discrepant with two studies reporting an increase, two reporting a decrease and the remaining three disclosing no change.
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Rosario et al. (2006) conducted a review in Chronic kidney disease (CKD) and end-stage renal disease (ESRD). Erythropoietin (EPO) was evaluated on Plasma renin activity (PRA) and aldosterone (ALDO) levels. Erythropoietin administration in ESRD patients resulted in no change in plasma renin activity in 9 studies and a decrease in 4 studies, with discrepant effects on aldosterone.
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