Impact of recombinant human erythropoietin treatment on left ventricular hypertrophy and cardiac function in dialysis patients

The results of anemia correction by recombinant human erythropoietin (rHuEP O) therapy with regard to cardiac function and left ventricular Abstract hy pertrophy in dialysis patients are controversially discussed. The aim of th e study was to assess the effects of therapy rHuEPO on cardiac morphology a nd function in dialysis patients. We studied 11 clinically stable hemodialy sis patients with severe renal anemia (hematocrit <27%) and increased left ventricular mass index (LVMi) with no history of coronary or valvular heart disease, systemic disease, severe hyperparathyroidism, hypertension stage 2 or higher, transfusion-dependent anemia, and concurrent rHuEPO treatment. The patients were treated with rHuEPO administered subcutaneously once or twice weekly at a mean dose of 80 +/- 31 IU/kg week until the hematocrit wa s >30% and underwent a complete Doppler echocardiographic study at baseline and at follow-up (after 12.2 +/- 2.9 months). At follow-up, ejection fract ion and fractional shortening significantly increased from 62.7 +/- 13.8 to 67.8 +/- 9.7% (p < 0.05) and from 35.5 +/- 9.8 to 39.4 +/- 7.1% (p < 0.05) , respectively, whereas mean velocity of circumferential fiber shortening d emonstrated a trend towards amelioration from 1.18 +/- 0.23 to 1.27 +/- 0.2 7 circ/s (n.s.). LVMi and morphological data remained unchanged throughout the study. Nevertheless, LVMi changes showed two different behaviors with r espect to baseline values: in 6 patients with higher baseline values, LVMi decreased from 229 +/- 36 to 191 +/- 45 g/m(2) (p < 0.05), while it worsene d in 5 patients with less marked LVMi increasing from 141 +/- 32 to 186 +/- 40 g/m(2) (p < 0.05). Our data demonstrate that partial correction of rena l anemia with rHuEPO therapy seems to improve cardiac performance and to in duce a regression of left ventricular hypertrophy, particularly in patients with greater baseline hypertrophy, ultimately confirming the multifactoria l pathogenesis of left ventricular hypertrophy.