Effects of Optimized Heart Failure Therapy and Anemia Correction with Epoetin β on Left Ventricular Mass in Hemodialysis PatientsHampl H. · Hennig L. · Rosenberger C. · Amirkhalily M. · Gogoll L. · Riedel E. · Scherhag A.
aDepartment of Nephrology and Medical Intensive Care, Charité University Clinic, bInstitute of Cardiology, Charité University Clinic, cDepartment of Chemistry/Biochemistry, Free University, Berlin, and dI. Medical Clinic, Department of Cardiology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany
Background: In chronic hemodialysis (HD) patients, the presence and degree of left ventricular hypertrophy (LVH) correlates with mortality. Previous studies have shown that interventions, such as anemia correction or treatment of hypertension and/or chronic heart failure (CHF), can result in moderate regression of LVH. The primary objective of our study was to investigate the effects of a multi-interventional treatment strategy on LVH in HD patients. Methods and Results: In a series of 202 consecutive HD patients, we combined optimized CHF therapy, including β-blockers (BB), ACE inhibitors and angiotensin receptor blockers (ARBs), to target doses with full anemia correction by epoetin β (hemoglobin (Hb) target males 14.5 g/dl, females 13.5 g/dl). Serial echocardiograms were recorded every 3–6 months. Mean follow-up was 3.4 ± 1.2 years. Mean Hb at baseline was 11.4 ± 1.4 vs. 14.6 ± 1.6 g/dl (p < 0.001) at study end. There was a significant reduction in left ventricular mass index (LVMI, 159 ± 65 vs. 132 ± 46 g/m2 (p < 0.001)), an improvement in left ventricular ejection fraction (LVEF, 60 ± 15 vs. 66 ± 12% (p < 0.01)) and in NYHA class (2.8 ± 0.76 vs. 1.96 ± 0.76 (p < 0.01)) from baseline to follow-up in the overall study population. In a subgroup of 70 patients, LVMI returned to normal (169 ± 33 vs. 114 ± 14 g/m2 (p < 0.001)) after 1.4 ± 1 years. Conclusions: Our study shows that optimized CHF therapy, in combination with anemia correction to normal Hb targets, results in a significant reduction of LVH, an increase in LVEF and an improvement in NYHA class. Moreover, in contrast to previous studies, our data also demonstrate that complete regression and prevention of LVH in HD patients is possible.
Hannelore Hampl, MD
DE–10625 Berlin (Germany)
Tel. +49 30 315863/31586422, Fax +49 30 3133803, E-Mail email@example.com
Received: February 23, 2005
Accepted: April 27, 2005
Published online: May 18, 2005
Number of Print Pages : 10
Number of Figures : 3, Number of Tables : 6, Number of References : 59
American Journal of Nephrology
Vol. 25, No. 3, Year 2005 (Cover Date: May-June 2005)
Journal Editor: Bakris, G. (Chicago, Ill.)
ISSN: 0250–8095 (print), 1421–9670 (Online)
For additional information: http://www.karger.com/ajn