Cardiac mortality prevention in uremic patients. Therapeutic strategies with particular attention to complete correction of renal anemia.

BACKGROUND: Left ventricular hypertrophy represents the major risk factor for cardiac mortality and morbidity, with cardiac mortality being the most important determinant for survival in dialysis patients. The prevalence of left ventricular hypertrophy is already high at initiation of dialysis and increases with time. Anemia is considered as the most important factor for the development of left ventricular hypertrophy. Others already demonstrated that with partial correction of renal anemia by erythropoietin a partial regression of the left ventricular mass can be achieved. PATIENTS AND METHODS: We investigated the effect of complete correction of renal anemia to normal hemoglobin values of 14 g/dl (Hct 42%) on left ventricular hypertrophy by echocardiography. Eight Patients entered the study 4-8 weeks after initiation of chronic hemodialysis with a mean hemoglobin of 9.5 +/- 1.3 g/dl).
RESULTS: Left ventricular mass index (LVMI) decreased from 155 +/- 45 g/m2 to 123 +/- 18g/m2 (p < 0.05) within the observation period of 12 +/- 5 months. The results showed, that either normal left ventricular dimensions could be preserved or, if left ventricular hypertrophy was already present, complete regression was possible.
CONCLUSION: Therefore, we propose that complete correction of renal anemia should be introduced into the therapy of dialysis patients along with strict adherence to established measures for the control of left ventricular hypertrophy: control of fluid overload and arterial hypertension and the use of ACE-inhibitors and betablockers. In addition, optimal correction of metabolic acidosis, control of the calcium-phosphate product and hyperparathyreoidism must be attempted. Thus, it should be possible to reverse left ventricular hypertrophy and its deleterious consequences in the dialysis population in order to improve survival and quality of life.