Document Detail


Differences in blood volume components between hyporesponders and responders to erythropoietin alfa: the heart failure with preserved ejection fraction (HFPEF) anemia trial.
MedLine Citation:
PMID:  24125107     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Hyporesponders to erythropoietin-stimulating agents (ESAs) have been associated with an increased subsequent risk of death or cardiovascular events. We hypothesized that subjects who are hyporesponsive to erythropoietin alfa would have higher plasma volumes and lower red cell deficits than subjects who are responsive to therapy.
METHODS: As part of a prospective, single blind, randomized, placebo-controlled study comparing erythropoietin alfa with placebo in older adults (n = 56) with heart failure and a preserved ejection fraction (HFPEF), we performed blood volume analysis with the use of an indicator dilution technique with (131)iodine-labeled albumin. We evaluated differences in plasma volumes and red cell volumes in hyporesponders (eg, <1 g/dL increase in hemoglobin within the first 4 weeks of treatment with erythropoetin alfa) compared with subjects who were responders and controls.
RESULTS: Nine of 28 subjects (32%) assigned to ESA were hyporesponders. Hyporesponders did not differ from responders nor control subjects by any baseline demographic, clinical, or laboratory parameter, including hemoglobin. Hyporesponders had a greater total blood volume expansion (1,264.7 ± 387 vs 229 ± 206 mL; P = .02) but less of a red cell deficit (-96.2 ± 126 vs -402.5 ± 80.6 mL; P = .04) and a greater plasma volume expansion (+1,360.8 ± 264.5 vs +601.1 ± 165.5 mL; P = .01). Among responders, the increase in hemoglobin with erythropoietin alfa was associated primarily with increases in red cell volume (r = 0.91; P < .0001) as well as a decline in plasma volume (r = -0.55; P = .06).
CONCLUSIONS: Among older adults with HFPEF and anemia, hyporesponders to erythropoietin alfa had a hemodilutional basis of their anemia, suggesting that blood volume analysis can identify a cohort likely to respond to therapy.
Authors:
Margarita Borovka; Sergio Teruya; Julissa Alvarez; Stephen Helmke; Mathew S Maurer
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Publication Detail:
Type:  Clinical Trial, Phase II; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiac failure     Volume:  19     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-15     Completed Date:  2014-05-26     Revised Date:  2014-10-09    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  685-91     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anemia / drug therapy,  epidemiology,  physiopathology*
Blood Volume / drug effects,  physiology*
Erythrocyte Volume / drug effects,  physiology
Erythropoietin / pharmacology,  therapeutic use*
Female
Heart Failure / drug therapy,  epidemiology,  physiopathology*
Hemoglobins / metabolism
Humans
Male
Middle Aged
Plasma Volume / drug effects,  physiology
Prospective Studies
Recombinant Proteins / pharmacology,  therapeutic use
Retrospective Studies
Single-Blind Method
Stroke Volume / drug effects,  physiology*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K24 AG036778/AG/NIA NIH HHS; K24-AG036778-03/AG/NIA NIH HHS; R01 AG027518/AG/NIA NIH HHS; R01 AG027518/AG/NIA NIH HHS
Chemical
Reg. No./Substance:
0/Hemoglobins; 0/Recombinant Proteins; 11096-26-7/Erythropoietin; 113427-24-0/epoetin alfa
Comments/Corrections

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