Nephrology Dialysis Transplantation, Vol 12, Issue 5 924-932, Copyright © 1997 by Oxford University Press
V Allegra, L Martimbianco and A Vasile
Background. Long term effects of rHuEpo on the blood
lipid profile have not been well documented. The aim of this paper is to
prospectively evaluate whether rHuEpo therapy affects lipid metabolism, and
whether these effects are influenced by changes in dietary habits and by
route of rHuEpo administration. Methods. The study was
performed in 33 maintenance haemodialysis patients (MHP) treated for one
year with rHuEpo either intravenously (n = 15) or
subcutaneously (n = 18), three times per week at the
end of each dialysis session. The doses were 50 IU/kg intravenously or 35
IU/kg subcutaneously during the first 6 months and 20 IU/kg during the
following months. The control group consisted of 17 MHP not treated with
rHuEpo. Total cholesterol, LDL-cholesterol and HDL-cholesterol,
triglycerides, apolipoproteins A1 and B, haemoglobin, serum albumin, blood
urea nitrogen, serum creatinine, Kt/V, protein catabolic rate, and plasma
erythropoietin were assessed at months 0, 2, 4, 6, 9, 12 and 2 weeks after
rHuEpo discontinuation. Changes in food intake were evaluated on the basis
of weekly dietary diaries before, and 3 and 9 months after treatment.
Patients were divided into two groups: group A consisted of 19 patients who
showed an increase in their energy intake (10% or more of basal value), and
group B was formed by 14 patients without or with slight changes in their
food intake. After the 6th month, dialysis schedules were adapted to new
protein catabolic rate values in patients who increased their food intake.
Results. During follow-up, there were no significant
changes in any of the parameters in the control group. In group A, blood
urea nitrogen, serum creatinine, protein catabolic rate, cholesterol, LDL
cholesterol, triglycerides and apolipoprotein B increased significantly
since the first months of rHuEpo treatment, and changes in cholesterol and
apolipoprotein B correlated significantly with changes in protein catabolic
rate. In group B, cholesterol, LDL cholesterol, and apolipoprotein B
decreased significantly after the 6th month of treatment, without changes
in blood urea nitrogen, serum creatinine and protein catabolic rate values.
In both groups A and B, HDL cholesterol decreased significantly until the
6th month and returned to basal values in the following months and
apolipoprotein A1 decreased until the 4th month and rose to levels higher
than basal values in the following months. First rHuEpo administration and
rHuEpo suspension at end of follow-up did not show any acute effect on
lipid profile, despite significant changes in plasma erythropoietin values.
Changes in lipid profile were similar with intravenous and subcutaneous
administration of rHuEpo. Conclusions: We infer that
long-term rHuEpo treatment positively affects the lipid profile, but in
some patients who show exaggerated increase in their food intake these
effects may be balanced and overcome by increment in some atherogenic blood
lipid fractions. The changes in lipid and apolipoprotein patterns during
rHuEpo therapy are not influenced by route of rHuEpo administration.
Keywords: apolipoproteins; erythropoietin;
haemodialysis; lipid metabolism; cardiovascular risk
ORIGINAL ARTICLES
Lipid and apolipoprotein patterns during erythropoietin therapy: roles of erythropoietin, route of administration, and diet
Servizio Emodialisi, Ospedale Civile, I-33057 Palmanova, Italy; Corresponding author
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