Effects of erythropoietin on left ventricular hypertrophy in adults with severe chronic renal failure and hemoglobin <10 g/dL.
BACKGROUND
Left ventricular hypertrophy (LVH) frequently complicates chronic renal insufficiency. Anemia is also common in these patients and may contribute to LVH.


METHODS
We conducted an open-label interventional trial to evaluate the effect of recombinant erythropoietin (rhEPO) on left ventricular mass index (LVMI) in anemic patients with renal insufficiency. Adults with creatinine clearance 10 to 30 mL/min (nondiabetics) or 20 to 40 mL/min (diabetics) were recruited, and rhEPO was given to those with anemia (hemoglobin level <10 g/dL). Baseline and 6-month LVMI and LVH (LVMI >130 g/m(2) in men and >100 g/m(2) in women), hemoglobin levels, creatinine clearance, blood pressure, medications, and medical history were obtained. Forty anemic and 61 nonanemic control subjects were enrolled.


RESULTS
Overall, the prevalence of LVH was 68.3% (95% CI 58.3-77.2), and entry hemoglobin level was the only significant predictor of baseline LVH (adjusted OR 0.69 per g/dL increase in hemoglobin, 95% CI 0.50-0.94). After 6 months, LVMI decreased in anemic patients receiving rhEPO (142 +/- 56 vs. 157 +/- 56 g/m(2)) (P= 0.007), with an increase in hemoglobin (11.3 +/- 1.9 vs. 9.1 +/- 0.7 g/dL) (P= 0.001). There were no changes in LVMI or hemoglobin level among controls. After adjusting for confounders and change in hemoglobin, receipt of rhEPO was associated with a significant reduction in LVMI (P= 0.01).


CONCLUSIONS
Treatment with rhEPO was not independently associated with significant changes in blood pressure or renal function. LVH is a common finding in chronic renal insufficiency and is associated with lower hemoglobin levels. Treatment with rhEPO may decrease LVH in patients with severe renal insufficiency and anemia.
Ayus
Juan Carlos
JC
The University of Texas Health Science Center at San Antonio, San Antonio, Texas 782293, USA. ayus@uthscsa.edu
Go
Alan S
AS
Valderrabano
Fernando
F
Verde
Eduardo
E
de Vinuesa
Soledad Garcia
SG
Achinger
Steven G
SG
Lorenzo
Victor
V
Arieff
Allen I
AI
Luño
Jose
J
D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D001794:Blood Pressure; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006454:Hemoglobins; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000453:epidemiology; D007668:Kidney / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011994:Recombinant Proteins; D012720:Severity of Illness Index
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin