ERYTHROPOIETIN THERAPY IS NOT RELATED TO NON-DIPPING PATTERN AND INCREASED CARDIOVASCULAR MORTALITY IN PATIENTS UNDERGOING CHRONIC HEMODIALYSIS

Abstract

Objective: ABPM is superior to dialysis center measurements in predicting cardiovasular (CV) events in patients undergoing chronic hemodialysis (HD). It was found that non-dipping pattern is assocated with poor prognosis. There is currently no evidence linking erythropoiesis-stimating agents (ESAs)-induced hypertension with increased CV morbidity and mortality. It was proposed that long-acting ESA may have a lower hypertensive effect than short-acting ESAs. Our aim was to analyze association of non-dipping pattern, ESA therapy and CV mortality in patients undergoing chronic HD. Design and method: 164 patients (103 M, 61 F; averaged age 65.2), who had been on intermittent HD treatment for more than 6 months, were enrolled in (88.5% hypertensives, 28.6% diabetics, 19.5% smokers) and followed up for average 25.7 months. Patients received HD treatment 4 hr/session 3 times a week during the study period. Average number of antihypertensive drugs was 2.63 (the most prescribed were CaB followed by beta-blockers, ACEi/ARBs, diuretics, central-acting drugs, urapidil and direct vasodilatators: 60.7%, 54.4%, 38.9%, 34.8%, 30.3%, 26.9% and 6.9%, respectively). There were 43.9% of patients on short- and 56.1% of patients on long-acting ESAs. At basal 24 h ABPM (Spacelab) was performed following the ESH/ESC guidelines on non-dialysis midweek day. Data of subjects with more than 70% successful ABPM readings were analyzed. Nondipping was defined as nighttime BP aver Results: Non-dipping pattern was found in 77.4% patients. No differences were found in age, dialysis parameters, comorbidity, chronic HD therapy and laboratory parameters between dippers and non-dippers. However, CV mortality was significantly higher in non-dippers (28.9% vs.16.0%, p = 0.02). Deceased patients were significantly older, had higher serum calcium and iPTH levels and day-time mean arterial pressure levels. There were no differences in number of antihypertensive drugs, proportion of patients with hypertension, diabetes or smokers.No difference was found between patients treated with short- and long-acting ESAs. Conclusions: Observed increased CV mortality in patients undergoing chronic HD is related to non-dipping pattern and is not associated with the type of used ESAs. Mechanisms of increased non-dipping pattern and associated poor prognosis should be evaluated in larger prospective cohorts.