title: Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents.
abstract: BACKGROUND
  Recent experimental studies suggest that erythropoietin promotes beneficial myocardial remodeling during left ventricular hypertrophy (LVH); however, such compensatory capacity may be limited due to insufficient erythropoietin production in chronic kidney disease patients. Thus, this study aimed to explore the effect of pre-dialysis erythropoiesis-stimulating agent (ESA) use on the prognostic significance of LVH in dialyzed patients.
  
  
  METHODS
  This retrospective study included 404 consecutive patients who started dialysis between 2001 and 2009. The interaction of ESA with the association between left ventricular mass index (LVMI) observed at dialysis initiation and all-cause and cardiovascular mortality was analyzed at the end of 2010 using the Cox model.
  
  
  RESULTS
  During a median follow-up of 36.5 months, 164 patients died, 31 of them from heart failure. The frequency of pre-dialysis ESA use was 58.7 % and median LVMI was 160.3 g/m(2). Of interest, patients with the lowest tertile of LVMI had worse survival compared with those with each subsequent tertile. LVMI was inversely associated with all-cause mortality [hazard ratio (HR) 0.991, 95 % confidence interval (CI) 0.988-0.995, P = 0.000] after extensive adjustment including ejection fraction, whereas the prognostic value of LVMI for cardiovascular mortality was dependent on pre-dialysis ESA use [adjusted HR 1.010, 95 % CI 0.999-1.020, P = 0.065 for pre-dialysis ESA(+) and 0.978, 95 % CI 0.967-0.989, P = 0.000 for pre-dialysis ESA(-), respectively].
  
  
  CONCLUSIONS
  Our results suggest that reverse epidemiology may exist between LVH and mortality and that pre-dialysis ESA use may modify the prognostic significance of LVH observed at dialysis initiation for cardiovascular mortality in dialyzed patients.
authors.affiliation: Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan. t-hayashi@abelia.ocn.ne.jp
authors.forename: Terumasa
authors.initials: T
authors.lastname: Hayashi
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kimura
authors.forename: Keiko
authors.initials: K
authors.lastname: Yasuda
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Obi
authors.forename: Koichi
authors.initials: K
authors.lastname: Sasaki
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Iio
authors.forename: Kenro
authors.initials: K
authors.lastname: Miyasato
authors.forename: Taro
authors.initials: T
authors.lastname: Kamimura
authors.forename: Harumi
authors.initials: H
authors.lastname: Kitamura
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
authors.forename: Hiromi
authors.initials: H
authors.lastname: Rakugi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Isaka
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D003625:Data Collection; D003929:Diabetic Neuropathies / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006397:Hematinics / Q000494:pharmacology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013268:Stimulation, Chemical; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D006397:Hematinics