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.
Renal Centre, Consulting Institution for Home Dialysis and Kidney Transplantation, Berlin, Germany. hannahampl@web.de
Hannelore
H
Hampl
Lars
L
Hennig
Christian
C
Rosenberger
Lutz
L
Gogoll
Eberhard
E
Riedel
Armin
A
Scherhag
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