Analysis of Heart Morphology and Function Following Erythropoietin Treatment of Anemic Dialysis Patients

Abstract

In a two-way study, we treated renal anemia in chronic hemodialysis patients with recombinant human erythropoietin (rh-EPO) and followed heart morphology and function dynamics by echocardiography. Thirty-eight patients were randomly divided in two equal groups: the therapy group, treated with rh-EPO for 24 months, and the control group, not treated during the first 12 months and treated with rh-EPO during the second 12 months. Anemia was corrected, and hematocrit was maintained between 30 and 35 vol% by subcutaneous rh-EPO administration. Echocardiographic assessment was performed at the end of the untreated control phase and was repeated after 12 months of rh-EPO treatment in the control group and after 12 and 24 months of treatment in the therapy group. The results revealed significant morphologic, hemodynamic, and eventually functional changes. After 12 months of rh-EPO treatment, the end-diastolic volume (EDV) decreased from 135.8 +/- 23.7 to 109.8 +/- 25.3 ml, p < 0.001; stroke volume (SV) from 91.9 +/- 17.6 to 71.3 +/- 12.4 ml, p < 0.001; left ventricular mass-Devereux (LVMD) from 297.2 +/- 57.8 to 218.0 +/- 50.4 g, p < 0.01; cardiac output (CO) from 7,279 +/- 1,932 to 5,711 +/- 1,276 ml/min, p < 0.002; total peripheral resistance (TPR) rose from 1,330 +/- 390 to 1,707 +/- 373 dynes x s/cm5, p < 0.007. After 24 months, LVMD decreased further from 224.6 +/- 43.1 to 195.7 +/- 46.3 g, p < 0.004. The relaxation time index (RTI) decreased from 64.7 +/- 20.4 to 52.4 +/- 18.0 ms, p < 0.045, suggesting improved diastolic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Double-Blind Comparison of Full and Partial Anemia Correction in Incident Hemodialysis Patients without Symptomatic Heart Disease

“…Both uncontrolled (30,31) and controlled (14) studies have shown that partial correction of anemia leads to partial regression of LVH in dialysis patients, in addition to improving QOL and physical performance (12,13). Three controlled studies of normalization of hemoglobin with erythropoietin in hemodialysis populations have been reported to date.…”

“…In dialysis patients, anemia is associated with LVH, left ventricular dilation, congestive heart failure, hospitalization, and mortality (8 -11). Controlled studies with quality of life (QOL) and left ventricular mass as end points support partial correction of hemoglobin in dialysis patients (12)(13)(14).…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…There is reasonably good evidence that partial correction of anemia improves LVH and reduces mortality among hemodialysis patients (745,746). Similarly, some small studies suggest that partially correcting anemia in patients with renal insufficiency helps to reduce LVH (747).…”

The Role of Anemia in the Progression of Congestive Heart Failure: Is There a Place for Erythropoietin and Intravenous Iron?

“…Treatment of anemic patients who have renal failure with EPO has resulted in reduced LV mass, [69][70][71][72][73][74][75] LV mass index (LVMI), [74][75][76][77][78][79][80][81] improved LVEF,1, 69-71,74,75,82-86 and a reduction in both LV end systolic volumes 69,70,74,75,84,85 and LV end diastolic volumes. 69,70,74,75,84,85 In addition, in one study, treating the anemia caused the LVH and LV diastolic volumes to improve. When the EPO was stopped for a year, however, both the LVH and LV end diastolic volume returned to their previous levels.…”