Left Ventricular Geometry Predicts Cardiovascular Outcomes Associated with Anemia Correction in CKD
Open Access
- 1 December 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Society of Nephrology
- Vol. 20 (12), 2651-2660
- https://doi.org/10.1681/asn.2009060631
Abstract
Partial correction of anemia in patients with chronic kidney disease (CKD) reduces left ventricular hypertrophy (LVH), which is a risk factor for cardiovascular (CV) morbidity, but complete correction of anemia does not improve CV outcomes. Whether LV geometry associates with CV events in patients who are treated to different hemoglobin (Hb) targets is unknown. One of the larger trials to study the effects of complete correction of anemia in stages 3 to 4 CKD was the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial. Here, we analyzed echocardiographic data from CREATE to determine the prevalence, dynamics, and prognostic implications of abnormal LV geometry in patients who were treated to different Hb targets. The prevalence of LVH at baseline was 47%, with eccentric LVH more frequent than concentric. During the study, LVH prevalence and mean left ventricular mass index did not change significantly, but LV geometry fluctuated considerably within 2 yr in both groups. CV event-free survival was significantly worse in the presence of concentric LVH and eccentric LVH compared with the absence of LVH (P = 0.0009 and P ≤ 0.0001, respectively). Treatment to the higher Hb target associated with reduced event-free survival in the subgroup with eccentric LVH at baseline (P = 0.034). In conclusion, LVH is common and associates with poor outcomes among patients with stages 3 to 4 CKD, although both progression and regression of abnormal LV geometry occur. Complete anemia correction may aggravate the adverse prognosis of eccentric LVH.Keywords
This publication has 46 references indexed in Scilit:
- Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD PatientsClinical Journal of the American Society of Nephrology, 2009
- Secondary analysis of the CHOIR trial epoetin-α dose and achieved hemoglobin outcomesKidney International, 2008
- Erythropoietin treatment elevates haemoglobin concentration by increasing red cell volume and depressing plasma volumeJournal Of Physiology-London, 2006
- Correction of Anemia with Epoetin Alfa in Chronic Kidney DiseaseThe New England Journal of Medicine, 2006
- Signaling Pathways for Cardiac Hypertrophy and FailureThe New England Journal of Medicine, 1999
- Left ventricular mass index increase in early renal disease: Impact of decline in hemoglobinAmerican Journal of Kidney Diseases, 1999
- Outcome and risk factors for left ventricular disorders in chronic uraemiaNephrology Dialysis Transplantation, 1996
- Analysis of Heart Morphology and Function Following Erythropoietin Treatment of Anemic Dialysis PatientsArtificial Organs, 1993
- Vascular changes in hemodialysis patients in response to recombinant human erythropoietinKidney International, 1989
- Impact of left ventricular hypertrophy on survival in end-stage renal diseaseKidney International, 1989