Regression of left ventricular hypertrophy after partial correction of anemia with erythropoietin in patients on hemodialysis: a prospective study.
Myocardial effects of recombinant human erythropoietin (rhEPO) treatment were prospectively investigated in 15 hemodialysis (HD) patients with severe anemia (hematocrit [Ht] 19.7 +/- 2.5%). Echocardiographic studies were performed after a midweek HD session just before and after a year of rhEPO. At the end of the study period, Ht had improved to 32.2 +/- 3.5% and cardiac index significantly decreased (5.48 +/- 1.54 vs 3.97 +/- 0.94 l/min/m2, p less than 0.001). Left ventricular mass index (LVMi) decreased with rhEPO (210.7 +/- 48.3 vs 139 +/- 50 g/m2, p less than 0.05). This decrease was concomitant with a decrease of LV end-diastolic diameter (4.89 +/- 0.44 vs 4.57 +/- 0.64 cm, p less than 0.05), interventricular septum thickness (IVST, 1.42 +/- 0.33 vs 1.07 +/- 0.13 cm, p less than 0.01) and LV posterior wall thickness (LVPWT, 1.28 +/- 0.21 vs 1.01 +/- 0.11 cm, p less than 0.01). Eight patients were hypertensive well controlled with hypotensive drugs (group I) and 7 normotensive (group II). LVMi was higher in group I than in group II before rhEPO (235.2 +/- 40 vs 182.7 +/- 43.1 g/m2, p less than 0.05) and significantly decreased after rhEPO in both groups (28.5% and 41.4% respectively). LVMi remained higher in group I than in group II at the end of the study (168.5 +/- 0.9 vs 106.7 +/- 24 g/m2, p less than 0.025). A moderately elevated IVST/LVPWT was reduced with a year of rhEPO (1.14 +/- 0.40 vs 1.05 +/- 0.15, p less than 0.05), disclosing correction of asymmetric septal hypertrophy. We conclude that left ventricular hypertrophy (LVH) regression is obtained after partial correction of anemia with rhEPO. Previous hypertension with current need of antihypertensive treatment has also a significant effect in the development of LVH. Whether this regression would improve outcome in HD patients remains to be established.
Pascual
J
J
Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
Teruel
J L
JL
Moya
J L
JL
Liaño
F
F
Jiménez-Mena
M
M
Ortuño
J
J
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D006332:Cardiomegaly / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D003131:Combined Modality Therapy; D004341:Drug Evaluation; D004452:Echocardiography; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006400:Hematocrit; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects*
D011994:Recombinant Proteins; D004921:Erythropoietin