Effects of Optimized Heart Failure Therapy and Anemia Correction with Epoetin β on Left Ventricular Mass in Hemodialysis Patients

Vol. 25, No. 3, 2005

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Original Report: Patient-Oriented, Translational Research

Effects of Optimized Heart Failure Therapy and Anemia Correction with Epoetin on Left Ventricular Mass in Hemodialysis Patients
Hannelore Hampl^a, Lars Hennig^b, Christian Rosenberger^a, Masoud Amirkhalily^b, Lutz Gogoll^b, Eberhard Riedel^c, Armin Scherhag^d

^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

Address of Corresponding Author

Am J Nephrol 2005;25:211-220 (DOI: 10.1159/000085881)

Key Words

Heart failure therapy
Hemodialysis
Anemia management
Left ventricular hypertrophy

Abstract

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 beta -blockers (BB), ACE inhibitors and angiotensin receptor blockers (ARBs), to target doses with full anemia correction by epoetin beta (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.

Author Contacts

Hannelore Hampl, MD
Dialysis Center
Bismarckstrasse 97-98
DE-10625 Berlin (Germany)
Tel. +49 30 315863/31586422, Fax +49 30 3133803, E-Mail h.hampl@je-web.de

Article Information

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

Medline Abstract (ID 15900093)

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