There is a clear relationship between anaemia and cardiovascular risk in ch
ronic renal failure (CRF) patients. Left ventricular hypertrophy (LVH) is p
resent in about three-quarters of patients starting dialysis, and is a stro
ng predictor of mortality. Anaemia contributes to the development of LVH, m
ainly via increased cardiac output. In some patients, anaemia results in an
increase in LV mass, while in others it also results in LV end-diastolic v
olume dilatation. These changes increase the risk of arrhythmias, myocardia
l infarction and myocardial fibrosis. The lower the haemoglobin, the more l
ikely it is that LVH and heart failure will develop. Furthermore, a haemogl
obin of <11 g/dl is associated with increased morbidity and mortality. Part
ial correction of anaemia with epoetin leads to a partial, but not complete
, reversal of LVH. One large prospective study (Lombardy Registry) found th
at epoetin treatment was accompanied by a 30% reduction in crude relative r
isk of mortality. A progressive reduction in the relative risk of general a
nd cardiovascular mortality was found with increasing haematocrit, with and
without adjustment for co-morbid conditions. Mean hospitalizations also de
creased with increasing haematocrit. The longterm effects of normalized hae
matocrit/haemoglobin values in uraemic patients have not yet been evaluated
exhaustively in prospective, randomized, multicentre studies. Epoetin trea
tment has been shown to induce lasting improvements in patients' sense of w
ell-being, reduce fatigue, increase appetite and work capacity, and improve
exercise tolerance, libido and work performance. Further studies are neede
d to demonstrate whether greater haemoglobin concentrations are associated
with greater improvements in quality of life during epoetin treatment.