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1 Nephrology and Hypertension, Univ. Med. Center Utrecht, Utrecht, Utrecht, Netherlands
2 Vascular medicine, Univ. Med. Center Utrecht, Utrecht, Utrecht, Netherlands
3 Cardiology, Univ. Med. Center Utrecht, Utrecht, Utrecht, Netherlands
4 Internal medicine, Meander Med. Center, Amersfoort, Utrecht, Netherlands
5 Amersfoort, Utrecht, Netherlands; Internal medicine, Meander Med. Center, Amersfoort, Utrecht, Netherlands
6 Utrecht, Utrecht, Netherlands; Cardiology, Univ. Med. Centre Utrecht, Utrecht, Utrecht, Netherlands
7 Utrecht, Utrecht, Netherlands; Nephrology and Hypertension, Univ. Med. Center Utrecht, Utrecht, Utrecht, Netherlands
* To whom correspondence should be addressed. E-mail: bbraam{at}gmail.com.
We have recently proposed the severe cardiorenal syndrome (SCRS), in which cardiac and renal failure mutually amplify progressive failure of both organs. This frequent pathophysiological condition has an extremely bad prognosis. Positive feedback between inflammation, the renin-angiotensin system, the balance between the nitric oxide and reactive oxygen species and the sympathetic nervous system form the cardiorenal connectors and are cornerstones in the pathophysiology of the severe cardiorenal syndrome. Absolute deficit of erythropoietin (Epo) and decreased sensitivity to Epo in this syndrome both contribute to the development of anemia, which is more pronounced than renal anemia in the absence of heart failure. Besides expression on erythroid progenitor cells, Epo receptors are present in the heart, kidney and vascular system, in which activation results in anti-apoptosis, proliferation, and possibly anti-oxidation and anti-inflammation. Interestingly, Epo can improve cardiac and renal function. We have therefore reviewed the literature with respect to Epo and the cardiorenal connectors. Indeed, there are indications that Epo can diminish inflammation, reduce renin-angiotensin system activity and shift the nitric oxide and reactive oxygen species balance towards nitric oxide. Information about Epo and the sympathetic nervous system is scarce. This analysis underscores the relevance of further understanding of clinical and cellular mechanisms underlying protective effects of Epo, since this will support a better treatment of the severe cardiorenal syndrome.
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