title: Anemia and left ventricular hypertrophy with renal function decline and cardiovascular events in chronic kidney disease.
abstract: BACKGROUND
  Anemia is a common complication in patients with chronic kidney disease (CKD), which may initiate or accelerate left ventricular hypertrophy (LVH). This study is designed to assess whether the coexistence of anemia and LVH is independently associated with the rate of renal function decline and increased cardiovascular events in patients with CKD stages 3 to 5.
  
  
  METHODS
  This longitudinal study enrolled 415 patients, who were classified into 4 groups according to sex-specific median values of hemoglobin and with/without LVH. The change in renal function was measured by estimated glomerular filtration rate slope. Cardiovascular events were defined as cardiovascular death, hospitalization for unstable angina, nonfatal myocardial infarction, sustained ventricular arrhythmia, hospitalization for congestive heart failure, transient ischemia attack, and stroke. The relative risk of cardiovascular events was analyzed by Cox's regression method.
  
  
  RESULTS
  The estimated glomerular filtration rate slope was significantly lower in the group with lower hemoglobin and LVH than in the other groups (P ≤ 0.031). In addition, patients with lower hemoglobin and LVH were independently associated with increased cardiovascular events (hazard ratio, 4.269; 95% confidence interval, 1.402-13.000; P = 0.011).
  
  
  CONCLUSIONS
  Our findings showed that the coexistence of anemia and LVH was independently associated with faster renal function decline and poor cardiovascular outcomes in patients with CKD. Assessments of serum hemoglobin level and LVH by echocardiography may help identify a high-risk group of poor renal and cardiovascular prognosis in patients with CKD stages 3 to 5.
authors: Division of Nephrology (J-MC, S-CC, J-CH, H-CC); and Division of Cardiology (H-MS), Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine (J-MC, S-CC, J-CH, H-MS), Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care (J-MC, H-CC); and Faculty of Medicine (S-CC, H-MS), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Jer-Ming
authors: JM
authors: Chang
authors: Szu-Chia
authors: SC
authors: Chen
authors: Jiun-Chi
authors: JC
authors: Huang
authors: Ho-Ming
authors: HM
authors: Su
authors: Hung-Chun
authors: HC
authors: Chen
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D013624:Taiwan / Q000453:epidemiology; D014463:Ultrasonography
chemical_list: D006454:Hemoglobins; D003404:Creatinine