Effect of anemia on cardiac disorders in pre-dialysis patients immediately before starting hemodialysis.
BACKGROUND
Anemia is a common complication of patients with chronic kidney disease (CKD), which not only lowers their quality of life but also potentially causes cardiovascular diseases such as congestive heart failure and coronary heart disease, and accelerates the progression of renal dysfunction.


METHODS
Pre-dialysis patients were assigned to groups A, B, C or D based on hemoglobin levels of ≤ 8.9 (n = 48), 9.0-9.9 (n = 63), 10-10.9 (n = 53), and ≥ 11.0 g/dL (n = 39), respectively. Cardiac function was estimated using echocardiography to clarify the relationship between anemia and cardiac disorders in patients with CKD immediately before starting hemodialysis.


RESULTS
Left ventricular ejection fraction (LVEF) was significantly higher in group D than in groups A and B. The fractions with an LVEF of less than 50% were 16.7, 4.8, 1.9, and 0% in groups A, B, C, and D, respectively. Posterior wall thickness was statistically thicker and the deceleration time of the early diastolic wave was longer in groups A and B, respectively, than in groups C and D. The left ventricular mass index in group D was significantly lower than in any other groups.


CONCLUSIONS
Anemia in pre-dialysis patients with CKD is a probable cause of impaired left ventricular systolic function and progressive left ventricular hypertrophy. Our results suggest that Hb levels should be maintained at >11 g/dL by EPO administration from the perspective of protecting cardiac function, although the upper limit of the target Hb level was undetermined.
Division of Nephrology, Shuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama 344-0035, Japan. kuwaharam@shuwa.or.jp
Michio
M
Kuwahara
Soichiro
S
Iimori
Tamaki
T
Kuyama
Wataru
W
Akita
Yoshihiro
Y
Mori
Tomoki
T
Asai
Yusuke
Y
Tsukamoto
Susumu
S
Adachi
Tatemitsu
T
Rai
Shinichi
S
Uchida
Sei
S
Sasaki
D000368:Aged; D000740:Anemia / Q000150:complications* / Q000209:etiology* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004452:Echocardiography; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy