title: Effects of early and late intervention with epoetin alpha on left ventricular mass among patients with chronic kidney disease (stage 3 or 4): results of a randomized clinical trial.
abstract: It is not known whether prevention of anemia among patients with chronic kidney disease would affect the development or progression of left ventricular (LV) hypertrophy. A randomized controlled trial was performed with 155 patients with chronic kidney disease (creatinine clearance, 15 to 50 ml/min), with entry hemoglobin concentrations ([Hb]) of 110 to 120 g/L (female patients) or 110 to 130 g/L (male patients). Patients were monitored for 2 yr or until they required dialysis; the patients were randomized to receive epoetin alpha as necessary to maintain [Hb] between 120 and 130 g/L (group A) or between 90 and 100 g/L (group B). [Hb] increased for group A (from 112 +/- 9 to 121 +/- 14 g/L, mean +/- SD) and decreased for group B (from 112 +/- 8 to 108 +/- 13 g/L) (P < 0.001, group A versus group B). On an intent-to-treat analysis, the changes in LV mass index for the groups during the 2-yr period were not significantly different (2.5 +/- 20 g/m(2) for group A versus 4.5 +/- 20 g/m(2) for group B, P = NS). There was no significant difference between the groups in 2-yr mean unadjusted systolic BP (141 +/- 14 versus 138 +/- 13 mmHg) or diastolic BP (80 +/- 6 versus 79 +/- 7 mmHg). The decline in renal function in 2 yr, as assessed with nuclear estimations of GFR, also did not differ significantly between the groups (8 +/- 9 versus 6 +/- 8 ml/min per 1.73 m(2)). In conclusion, maintenance of [Hb] above 120 g/L, compared with 90 to 100 g/L, had similar effects on the LV mass index and did not clearly affect the development or progression of LV hypertrophy. The maintenance of [Hb] above 100 g/L for many patients in group B might have been attributable to the relative preservation of renal function.
authors.affiliation: Department of Renal Medicine, Gosford Hospital, Gosford, Australia. sroger@doh.health.nsw.gov.au
authors.forename: Simon D
authors.initials: SD
authors.lastname: Roger
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: McMahon
authors.forename: Anthony
authors.initials: A
authors.lastname: Clarkson
authors.forename: Alex
authors.initials: A
authors.lastname: Disney
authors.forename: David
authors.initials: D
authors.lastname: Harris
authors.forename: Carmel
authors.initials: C
authors.lastname: Hawley
authors.forename: Helen
authors.initials: H
authors.lastname: Healy
authors.forename: Peter
authors.initials: P
authors.lastname: Kerr
authors.forename: Kelvin
authors.initials: K
authors.lastname: Lynn
authors.forename: Alan
authors.initials: A
authors.lastname: Parnham
authors.forename: Roess
authors.initials: R
authors.lastname: Pascoe
authors.forename: David
authors.initials: D
authors.lastname: Voss
authors.forename: Robert
authors.initials: R
authors.lastname: Walker
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
mesh_terms: D000740:Anemia / Q000209:etiology / Q000517:prevention & control*; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins; D013997:Time Factors
chemical_list: D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa