title: Anaemia and early phase cardiovascular events on haemodialysis.
abstract: Although the mechanism of the cardio-renal anaemia syndrome (CRAS) has been elucidated in considerable detail over the past decade, cardiovascular disease (CVD) remains a leading cause of death among patients with end-stage kidney disease (ESKD) undergoing haemodialysis, and these patients' cardiovascular mortality is greater than that of the general population. Recent studies have reported that the CVD risk increases with advancing chronic kidney disease (CKD) stage. Furthermore, the incidence of cardiovascular events is highest during the first week after dialysis initiation, with increased risk in incident haemodialysis patients. This accumulated evidence demonstrates that how patients are managed during the pre-dialysis phase may have important implications on long-term outcomes in ESKD. Anaemia, a non-traditional risk factor for CVD, advances exponentially along with declining kidney function due to insufficient erythropoietin production. Anaemia causes functional abnormalities of the heart, as represented by cardiac hypertrophy, which results from increased cardiac workload induced by an increased preload. Left ventricular hypertrophy (LVH), a traditional risk factor for CVD, is especially associated with advanced CKD stage and could be a major risk factor for cardiovascular complications such as ischaemic heart disease, heart failure, and sudden cardiac death. In ESKD, anaemia develops more severely and requires a higher amount of erythropoiesis-stimulating agent (ESA) therapy before dialysis initiation. This suggests that improvement in anaemia management during the pre-dialysis phase may have a beneficial effect on cardiac hypertrophy and contribute to reducing the CVD risk after initiating haemodialysis.
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Joki
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hase
mesh_terms: D000740:Anemia / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology*; D006321:Heart; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic; D012307:Risk Factors
keywords: anaemia; cardiovascular disease; chronic kidney disease; haemodialysis; left ventricular hypertrophy