Effects of erythropoietin on left ventricular hypertrophy in adults with severe chronic renal failure and hemoglobin <10 g/dL.

Abstract

BACKGROUND:

Left ventricular hypertrophy (LVH) frequently complicates chronic renal insufficiency. Anemia is also common in these patients and may contribute to LVH.

METHODS:

We conducted an open-label interventional trial to evaluate the effect of recombinant erythropoietin (rhEPO) on left ventricular mass index (LVMI) in anemic patients with renal insufficiency. Adults with creatinine clearance 10 to 30 mL/min (nondiabetics) or 20 to 40 mL/min (diabetics) were recruited, and rhEPO was given to those with anemia (hemoglobin level <10 g/dL). Baseline and 6-month LVMI and LVH (LVMI >130 g/m(2) in men and >100 g/m(2) in women), hemoglobin levels, creatinine clearance, blood pressure, medications, and medical history were obtained. Forty anemic and 61 nonanemic control subjects were enrolled.

RESULTS:

Overall, the prevalence of LVH was 68.3% (95% CI 58.3-77.2), and entry hemoglobin level was the only significant predictor of baseline LVH (adjusted OR 0.69 per g/dL increase in hemoglobin, 95% CI 0.50-0.94). After 6 months, LVMI decreased in anemic patients receiving rhEPO (142 +/- 56 vs. 157 +/- 56 g/m(2)) (P= 0.007), with an increase in hemoglobin (11.3 +/- 1.9 vs. 9.1 +/- 0.7 g/dL) (P= 0.001). There were no changes in LVMI or hemoglobin level among controls. After adjusting for confounders and change in hemoglobin, receipt of rhEPO was associated with a significant reduction in LVMI (P= 0.01).

CONCLUSION:

Treatment with rhEPO was not independently associated with significant changes in blood pressure or renal function. LVH is a common finding in chronic renal insufficiency and is associated with lower hemoglobin levels. Treatment with rhEPO may decrease LVH in patients with severe renal insufficiency and anemia.

• Authors: Juan Carlos Ayus, Alan S Go, Fernando Valderrabano, Eduardo Verde, Soledad Garcia de Vinuesa, Steven G Achinger, Victor Lorenzo, Allen I Arieff, Jose Luño, Spanish Group for the Study of the Anemia and Left Ventricular Hypertrophy in Pre-dialysis Patients
• Journal: Kidney international (Kidney Int) Vol. 68 Issue 2 Pg. 788-95 (Aug 2005) ISSN: 0085-2538 [Print] United States
• PMID: 16014057 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Hemoglobins
• Recombinant Proteins
• Erythropoietin

Topics

• Adult
• Aged
• Anemia (drug therapy, epidemiology, etiology)
• Blood Pressure
• Erythropoietin (administration & dosage)
• Female
• Hemoglobins
• Humans
• Hypertrophy, Left Ventricular (drug therapy, epidemiology)
• Kidney (physiology)
• Kidney Failure, Chronic (complications, drug therapy, epidemiology)
• Male
• Middle Aged
• Predictive Value of Tests
• Prevalence
• Recombinant Proteins
• Severity of Illness Index