Dose-dependent effect of continuous erythropoietin receptor activator on cardiac autonomic nervous activity and cardiovascular events in patients treated with online hemodiafiltration

Abstract

The purpose of the work was to determine the effect of continuous erythropoietin receptor activator (CERA) on the autonomic regulation of cardiac activity and cardiovascular events in patients treated with online hemodiafiltration (HDF). Materials and methods. A total of 105 stable chronic HDF patients were included in this prospective observational multicenter study. According to the CERA treatment, the patients were assigned to one of two groups: the 1st group (n = 73) received CERA for at least 6 months and the 2nd one (n = 32) consisted of HDF patients without CERA treatment for at least 6 months. The observational period was 3 years. Results. It was determined that the patients receiving CERA had a more potent dose-dependent activity of the sympathetic autonomic nervous system. The higher the parasympathetic tone predominance, the lower CERA dose was. The odds ratio for developing nonfatal cardiovascular events was 37 times higher in case of CERA more than 125 μg/month (χ2 = 32.2; P ˂ 0.0001). Conclusions. Thus, the results of this study have provided the preliminary evidence that the sympathetic ANS activity was greater in HDF patients receiving CERA and had a proportional dose-dependent nature. HDF patients with CERA treatment in a dose ≥125 µg/month had a significantly high risk of all cardiovascular events. Individual approach to low-dose CERA treatment in patients with CKD 5 and HDF could significantly reduce the risk of cardiovascular events.

Keywords

• renal replacement therapy
• hemodiafiltration
• anemia
• heart rate
• cardiovascular diseases