title: Erythropoiesis-stimulating agents, hypertension and left ventricular hypertrophy in the chronic kidney disease patient.
abstract: OBJECTIVE
  Left-ventricular hypertrophy (LVH) represents an important marker of cardiovascular morbidity and mortality. Numerous noninterventional studies in patients with chronic kidney disease (CKD) revealed a consistent relationship of LVH with modifiable risk factors attributable to failing renal function, particularly anemia and hypertension.
  
  
  RESULTS
  Given the clear role for anemia in initiating or accelerating LVH, it seems imperative to correct renal anemia with erythropoiesis-stimulating agents (ESAs). A few nonrandomized studies have described a regression of LVH with correction of anemia, but prospective randomized trials showed no evidence that ESA treatment is able to improve cardiac prognosis in the CKD patient. Current data alert physicians that normalization of hemoglobin in patients with advanced CKD is harmful. Recent studies are now trying to clarify the mechanisms for harm focussing on the influence of comorbidities, ESA doses, and hemoglobin variability. The pathogenesis of hypertension in CKD is multifactorial and only a small percentage of CKD patients have controlled their blood pressure, indicating poor medication adherence, insufficient control of volume overload and undertreatment.
  
  
  CONCLUSIONS
  This review provides an update of ESA treatment, hypertension and LVH in the CKD patient, indicating that pathogenesis of LVH in this population is currently not completely understood. In addition, the impact of pharmacological interventions targeted to prevent or reduce LVH in anemic or hypertensive CKD patients is not well defined. As adoption of the Framingham approach seems not feasible in the CKD patient, evidence from large-scale randomized clinical trials is mandatory to resolve this dilemma.
authors: KfH Nierenzentrum Muenchen-Laim, Department of Internal Medicine, University Hospital Munich, University of Munich, Munich, Germany. holger.schmid@lrz.uni-muenchen.de
authors: Holger
authors: H
authors: Schmid
authors: Helmut
authors: H
authors: Schiffl
authors: Stephan R
authors: SR
authors: Lederer
mesh_terms: D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018450:Disease Progression; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D006397:Hematinics; D006454:Hemoglobins