CARDIOVASCULAR-ABNORMALITIES IN END-STAGE RENAL-FAILURE - THE EFFECT OF ANEMIA OR UREMIA

Children with end stage renal failure and anaemia have an increased ca rdiac index and often gross ventricular hypertrophy. Correction of ana emia with recombinant human erythropoietin (r-HuEpo) for less than six months results in a reduction in the cardiac index without a signific ant reduction in left ventricular hypertrophy. Seven children receivin g dialysis (group 1) were studied to determine whether a reduction in left ventricular hypertrophy would occur after a 12 month period of r- HuEpo. A decrease in the cardiac index was seen by six months, and a s ignificant reduction in left ventricular mass index and cardiothoracic ratio was seen by 12 months. Successful renal transplantation also re sults in a reduction in the cardiac index and left ventricular hypertr ophy, but the relative contributions of correction of anaemia and corr ection of biochemical disturbance is unknown because they usually impr ove simultaneously. To investigate this, six children (group 2) who al ready had a mean haemoglobin concentration of 107 gfl while receiving dialysis were followed up for 12 months after successful transplantati on. They showed no significant change in haemoglobin concentration, bu t a dramatic improvement in biochemistry. There was no significant cha nge in cardiovascular function. Anaemia is the more dominant influence on cardiovascular function in end stage renal failure.