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Arterial Hypertension Induced by Erythropoietin and Erythropoiesis-Stimulating Agents (ESA)

Reto Krapf^*, and Henry N. Hulter

^* Department of Internal Medicine, Kantonspital Bruderholz, University of Basel, Basel, Switzerland; Department of Medicine, University of California, San Francisco, California

Correspondence: Dr. Reto Krapf, Department of Internal Medicine, Kantonspittal Bruderholz, CH4101 Bruderholz, Switzerland. Phone: 4161-421-2121; Fax: 4161-436–3670; E-mail: reto.krapf{at}ksbh.ch

This review summarizes the evidence for a hypertensinogenic effect of Erythropoietin (Epo) in normal human subjects and predialysis, hemodialysis, and continuous ambulatory peritoneal dialysis (CAPD) patients. The possible mechanisms of Epo-induced hypertension are examined with in vivo animal and in vitro data, as well as pathophysiological human studies in both normal subjects and CKD patients. The evidence for a hypertensinogenic effect of erythropoiesis-stimulating agents (ESAs) in normal subjects, predialysis CKD, hemodialysis, and CAPD patients is compelling. Epo increases BP directly and notably independently of its erythropoietic effect and its effect on blood rheology. The potential for the development of future agents that might act as specific stimulators of erythropoiesis, devoid of direct hemodynamic side effects is underscored.

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