INFLUENCE OF LONG-TERM AMELIORATION OF ANEMIA AND BLOOD-PRESSURE CONTROL ON LEFT-VENTRICULAR HYPERTROPHY IN HEMODIALYZED PATIENTS

The course of left ventricular hypertrophy was investigated in anemic hemodialysis patients treated with recombinant human erythropoietin (r-huEPO). 12 patients, aged 60.8 +/- 9.9 years (mean +/- SD) were treated for 18.8 +/- 2.7 months. Left ventricular size was estimated by echocardiography performed before treatment and at least 12 months after relieving anemia. Patients had signs of left ventricular and/or asymmetric septal hypertrophy when compared with a nonanemic and normotensive control group matched for sex and age. At baseline, hemoglobin (Hb) was 8.6 +/- 0.7 g/dl, interventricular septum thickness (IVST) was 1.75 +/- 0.34 cm, left ventricular posterior wall thickness (LVPWT) 1.32 +/- 0.19cm,left ventricular muscle mass index (LVMI) 222.7 +/- 41 g/ml and blood pressure (BP) 146.4 +/- 10/81.6 +/- 6 mm Hg. Hb rose to 11.4 +/- 1.2 g/dl (p < 0.001); IVST and LVMI decreased to 1.42 +/- 0.35 cm (p < 0.02) and 155.4 +/- 25.1 g/m2 (p < 0.001); LVPWT and BP remained unchanged (1.30 +/- 0.26 cm and l46.8 +/- 16.9/81.2 +/- 7.8 mmHg) at the end of the study. During the observation period, two groups of 5 and 7 patients differed from each other. The group of 5 patients had higher BP values (158.9 +/- 9.8/86.5 +/- 5.3 vs. 140.0 +/- 9.5/79.2 +/- 6.8 mm Hg, p < 0.01), and the period with Hb values above 10 g/dl was shorter (14.5 +/- 2.4 vs. 17.8 +/- 2.4 months, p < 0.05). These 5 patients failed to show a significant decrease in IVST and LVMI. We conclude that long-term amelioration of anemia in hemodialysis patients is able to induce a regression of left ventricular hypertrophy. However, inadequate BP control may compromise this effect in patients treated with r-huEPO.