title: Effect of anemia correction on left ventricular hypertrophy in patients with modestly high hemoglobin level and chronic kidney disease .
abstract: OBJECTIVE
  To assess effects of long-term anemia management on left ventricular hypertrophy in patients with chronic kidney disease (CKD) not on dialysis, we performed secondary outcome analyses of a randomized controlled study that evaluated effects of anemia management with erythropoiesis stimulating agents in this population.
  
  
  METHODS
  Subjects [hemoglobin (Hb)<10.0 g/dL, 2.0 ≤ serum creatinine<6.0mg/dL] were randomized either to high Hb (11.0 ≤ target Hb ≤ 13.0 g/dL with darbepoetin alfa), or to low Hb group (9.0 ≤ target Hb ≤ 11.0 g/dL with recombinant human erythropoietin), and followed up to 48 weeks. Data from echocardiographic evaluation and values of neurohumoral factors associated with heart failure were assessed in subjects whose data were evaluable both at the baseline and at the end point.
  
  
  RESULTS
  The high Hb group achieved target range Hb levels (12.1 ± 1.1g/dL, at 32 weeks, N=111), which was significantly higher (p<0.001) than the low Hb group (N=95). Though blood pressure and renal function changes were similar between the groups, left ventricular diastolic dimension was significantly decreased only in the high Hb group (p < 0.001), and the change in left ventricular mass index (LVMI) correlated coarsely but significantly with the achieved Hb levels (r = 0.147, p = 0.032). The higher Hb levels were associated with greater reduction in LVMI and left ventricular wall thickness, and the lower Hb levels with the greater increase in human arterial- or brain natriuretic polypeptide levels.
  
  
  CONCLUSIONS
  Anemia correction targeting modestly higher Hb levels better preserves cardiac function in CKD patients not on dialysis.
authors.affiliation: Department of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan. Electronic address: akaishim@insti.kitasato-u.ac.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Akaishi
authors.forename: Michiaki
authors.initials: M
authors.lastname: Hiroe
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hada
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood* / Q000150:complications* / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D045265:Natriuretic Peptides / Q000097:blood; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D045265:Natriuretic Peptides
keywords: Cardiovascular disease; Drug therapy; Hypertrophy; Natriuretic peptide; Renal function