Document Detail

Long-term effects of erythropoietin therapy on fistula stenosis and plasma concentrations of PDGF and MCP-1 in hemodialysis patients.
MedLine Citation:
PMID:  9219165     Owner:  NLM     Status:  MEDLINE    
Among the adverse effects possibly associated with the use of erythropoietin (EPO) in hemodialysis patients is an increased incidence of thrombosis of the vascular access. However, little is known about the effect of EPO on the stenotic lesion in the venous outflow system, which is the leading cause of fistula thrombosis. This study was designed to explore the long-term effects of EPO treatment on progressive fistula stenosis and the plasma concentrations of some potential mediators of neointimal hyperplasia. A cross-sectional and 3-yr prospective, placebo-controlled, pilot study was performed in 30 hemodialysis patients with native arteriovenous fistula. Sixteen patients received EPO and 14 received a placebo. Venous dialysis pressure, urea recirculation, color Doppler sonography, and angiography were used to monitor vascular access patency. Compared with 60 healthy subjects, the hemodialysis patients had elevated plasma levels of platelet-derived growth factor, monocyte chemoattractant protein-1, and interleukin 6, three proteins that might be involved in the neointima formation regulating the proliferation of vascular smooth muscle cells. In addition, these patients had numerous endothelial and hemostatic abnormalities that indicated a thrombophilic state. Eleven patients, six (37.5%) receiving EPO and five (35.7%) taking placebo, developed a progressive stenosis in the venous circuit of the fistula. There was no significant difference in the vascular access, event-free survival over 36 mo between patients receiving EPO therapy and placebo. EPO induced a significant decrease in the plasma values of platelet-derived growth factor and vascular cell adhesion molecule-1 and an increase of monocyte chemoattractant protein-1 concentration. After EPO withdrawal, these parameters returned to pretreatment levels. In conclusion, long-term EPO therapy does not increase the risk of progressive stenosis of native arteriovenous fistula. The use of erythropoietin does not induce any prothrombotic change in hemostatic parameters, and further studies are required to elucidate the theoretically beneficial effects on the plasma concentration of some potential mediators of neointimal formation.
S De Marchi; E Cecchin; E Falleti; R Giacomello; G Stel; G Sepiacci; N Bortolotti; F Zanello; F Gonano; E Bartoli
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  8     ISSN:  1046-6673     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-09-24     Completed Date:  1997-09-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1147-56     Citation Subset:  IM    
Department of Internal Medicine, DIPS, University of Udine Medical School, Italy.
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MeSH Terms
Apolipoproteins / blood
Arteriovenous Shunt, Surgical / adverse effects*
Cell Adhesion Molecules / blood
Chemokine CCL2 / blood*
Constriction, Pathologic
Cross-Sectional Studies
Cytokines / blood
Erythropoietin / adverse effects*
Kidney Failure, Chronic / physiopathology,  therapy
Lipids / blood
Middle Aged
Platelet-Derived Growth Factor / metabolism*
Prospective Studies
Renal Dialysis / adverse effects*
Thrombophlebitis / etiology
Reg. No./Substance:
0/Apolipoproteins; 0/Cell Adhesion Molecules; 0/Chemokine CCL2; 0/Cytokines; 0/Lipids; 0/Platelet-Derived Growth Factor; 11096-26-7/Erythropoietin

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