What are the short-term and long-term consequences of anaemia in CRF patients?

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.