Left ventricular geometry predicts cardiovascular outcomes associated with anemia correction in CKD.
Partial correction of anemia in patients with chronic kidney disease (CKD) reduces left ventricular hypertrophy (LVH), which is a risk factor for cardiovascular (CV) morbidity, but complete correction of anemia does not improve CV outcomes. Whether LV geometry associates with CV events in patients who are treated to different hemoglobin (Hb) targets is unknown. One of the larger trials to study the effects of complete correction of anemia in stages 3 to 4 CKD was the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial. Here, we analyzed echocardiographic data from CREATE to determine the prevalence, dynamics, and prognostic implications of abnormal LV geometry in patients who were treated to different Hb targets. The prevalence of LVH at baseline was 47%, with eccentric LVH more frequent than concentric. During the study, LVH prevalence and mean left ventricular mass index did not change significantly, but LV geometry fluctuated considerably within 2 yr in both groups. CV event-free survival was significantly worse in the presence of concentric LVH and eccentric LVH compared with the absence of LVH (P = 0.0009 and P < or = 0.0001, respectively). Treatment to the higher Hb target associated with reduced event-free survival in the subgroup with eccentric LVH at baseline (P = 0.034). In conclusion, LVH is common and associates with poor outcomes among patients with stages 3 to 4 CKD, although both progression and regression of abnormal LV geometry occur. Complete anemia correction may aggravate the adverse prognosis of eccentric LVH.
Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Krankenhausstrasse 12, Erlangen, Germany. med4@uk-erlangen.de
Kai-Uwe
KU
Eckardt
Armin
A
Scherhag
Iain C
IC
Macdougall
Dimitrios
D
Tsakiris
Naomi
N
Clyne
Francesco
F
Locatelli
Michael F
MF
Zaug
Hans U
HU
Burger
Tilman B
TB
Drueke
D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D018572:Disease-Free Survival; D004452:Echocardiography; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011994:Recombinant Proteins; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D006454:Hemoglobins; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin