Optimized heart failure therapy and complete anemia correction on left-ventricular hypertrophy in nondiabetic and diabetic patients undergoing hemodialysis.
BACKGROUND
According to new guidelines, diabetes mellitus per se can be considered as stage I chronic heart failure (CHF). Available evidence suggests that patients suffering from both diabetes mellitus and renal insufficiency have disproportionately high rates of left-ventricular hypertrophy (LVH).


METHODS
Optimized heart failure therapy, including beta-blockers, ACE-inhibitors and AT II-type-1-receptor-blockers, was prescribed in combination with complete anemia correction using epoetin beta (target hemoglobin: 13.5 g/dl for women; 14.5 g/dl for men) to 230 patients (55% male) with ambulatory hemodialysis, including 60 patients (52% male) with diabetes. Echocardiographic follow-up examinations were performed over a mean period of 4.4 +/- 1.2 years.


RESULTS
Mean hemoglobin levels at the study end significantly increased to target levels in the entire study population and in patients with diabetes (both p < 0.001). Compared with baseline, significant improvements were seen in hemodialysis patients - both without and with diabetes - in left-ventricular mass index (-28.8 g/m2 [p < 0.001] and 29.0 g/m2 [p < 0.005], respectively), left-ventricular ejection fraction (+7.0% [p < 0.001] and +8.3% [p < 0.01], respectively) and in NYHA class (-0.84 [p < 0.01] and -1.12 [p < 0.01], respectively). Similar to the results in the overall population, a highly significant reduction in LVH (p < 0.005) and significant improvements in LVEF (p < 0.01) and NYHA class (p < 0.01) were seen in the high-risk subgroup of diabetic patients.


CONCLUSIONS
Patients undergoing hemodialysis, with or without concomitant diabetes, benefit considerably from optimized, multifactorial heart failure therapy combined with complete anemia correction.
Hampl
Hannelore
H
Renal Centre, Consulting Institution for Home Dialysis and Kidney Transplantation, Berlin, Germany. hannahampl@web.de
Hennig
Lars
L
Rosenberger
Christian
C
Gogoll
Lutz
L
Riedel
Eberhard
E
Scherhag
Armin
A
D000136:Acid-Base Equilibrium / Q000502:physiology; D000368:Aged; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D003928:Diabetic Nephropathies / Q000628:therapy*; D023381:Endpoint Determination; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D007501:Iron / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D006435:Renal Dialysis; D015996:Survival Rate
D007501:Iron