Elevated level of erythropoietin in congestive heart failure Relationship to renal perfusion and plasma renin

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Abstract
Background. In animal experiments reduction of renal perfusion can stimulate erythropoietin production. The relationship between renal haemodynamics and erythropoietin production is unknown in congestive heart failure. Objective. The aim was to study the relationship between serum erythropoietin and renal haemodynamics, plasma renin activity and haematocrit in patients with congestive heart failure and in healthy control subjects. Patients and methods. Serum erythropoietin, renal plasma flow, glomerular filtration rate and plasma renin activity were determined in 14 patients with acyanotic congestive heart failure, and 36 healthy controls. Results. Serum erythropoietin was significantly elevated in congestive heart failure 26.6 U l−1 (median) compared with controls 17.0 U l−1 despite a normal haematocrit, and increased with the severity of congestive heart failure (New York Heart Association class II: 17 U l−1 [n = 4]; class III: 30 U l−1 [n = 5]; class IV: 45 U l−1 [n = 5]). Significant inverse correlations between serum erythropoietin and renal plasma flow (r = −0.60, P < 0.03), and between serum erythropoietin and glomerular filtration rate, were found in congestive heart failure but not in the control subjects. A significant positive correlation (r = 0.71, P < 0.03) was demonstrated between serum erythropoietin and plasma renin activity in congestive heart failure. Conclusion. A severe reduction in renal perfusion in congestive heart failure appears to cause an increase in serum erythropoietin.

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