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Effects of Hemoglobin Normalization with Epoetin in Chronic Kidney DiseaseFuruland, Hans January 2005 (has links)
Anemia is common in patients with chronic kidney disease (CDK), contributes to reduced Quality of Life (QoL) and is associated with cardiovascular disease, morbidity and mortality. Epoetin raises hemoglobin (Hb) and increases QoL and physical exercise capacity. Because of concerns about safety and economics, current anemia treatment with epoetin aims to achieve subnormal Hb (110-120 g/l). Normalization of Hb may be of additional benefit regarding QoL and cardiovascular effects. The present study examines the effects of Hb normalization with epoetin on safety variables, QoL, graft function after kidney transplantation, dialysis adequacy, hemorheology, hemodynamics and cardiac autonomic function in CKD patients. In a randomized, multicenter study comprising 416 pre-dialysis and dialysis patients no difference was observed between patients treated to a normal or a subnormal Hb level on mortality, thrombovascular events, serious adverse events, vascular access thrombosis and residual renal function. QoL was enhanced in a subgroup of hemodialysis patients. Pretransplant epoetin treatment directed toward normal Hb levels did not result in worse graft function during 6 postoperative months. Dialysis adequacy was reduced in a subgroup of hemodialysis patients after normalization of Hb. The blood flow properties of pre-dialysis patients were altered. The hemorheological investigation demonstrated that Hb normalization caused a parallel increase in hematocrit and blood viscosity without other hemorheological changes. While the total peripheral resistance index increased, the cardiac index (CI) decreased. In a separate study cardiac autonomic function, measured by heart rate variability, was decreased in pre-dialysis patients. It was improved, but not fully normalized, by Hb normalization. On the basis of this study, Hb normalization with epoetin appears to be safe and increases QoL in hemodialysis patients though may result in lower dialysis adequacy and increased blood pressure. A reduction in CI and improved cardiac autonomic function indicate a positive effect on cardiovascular function.
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Régulations homéostatiques cardiovasculaires suite à une transfusion par échange avec du sang hyperagrégeant chez le ratVanier, Julie 12 1900 (has links)
Dans le but de vérifier l’impact d’un changement soudain dans l’agrégation
érythrocytaire sur certains paramètres cardiovasculaires, une transfusion par échange
sanguin du tiers du volume a été effectuée avec du sang hyperagrégeant chez le rat de
souche Brown Norway. La pression caudale, le volume cardiaque systolique, la
fraction d’éjection, le débit cardiaque, le rythme cardiaque et la résistance
périphérique à l’écoulement sanguin ont été observés non-intrusivement sur 19 jours
suite à la transfusion. Les rats ont été sacrifiés plus d’un mois suivant la transfusion
et une étude ex vivo de la réponse à deux agents dilatateurs (l’acétylcholine et le
nitroprussiate de sodium) a été menée sur les artérioles mésentériques. Des variations
des paramètres cardiovasculaires, soit le débit, le volume systolique et la résistance
périphérique, ont été remarquées dans les trois premiers jours posttransfusion. Une
résistance du muscle vasculaire lisse au monoxyde d’azote a été notée chez les rats
transfusés au sang hyperagrégeant alors qu’aucune dysfonction endothéliale n’était
apparente en réponse à l’acétylcholine. / The aim of this study was to evaluate the effects of an acute change in
erythrocyte aggregation on cardiovascular parameters by exchanging one third of the
blood volume with hyperaggregating blood in the Brown Norway rat model. Values
of caudal pressure, systolic cardiac volume, ejection fraction, cardiac output, heart
rate and peripheral resistance to blood flow were observed non-invasively over 19
days after transfusion. The rats were sacrificed after more than a month following the
procedure and an ex vivo study in response to pharmacological agents (acetylcholine
and sodium nitroprussiate) was performed on mesenteric arterioles. Variations in
cardiac output, systolic volume and peripheral resistance were noted for the first
three days post-transfusion. The vascular smooth muscles of rats transfused with the
hyperaggregating erythrocytes seemed to have developed a resistance to nitric oxide
but no endothelial dysfunction was observed in response to acetylcholine.
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