Cardiac mortality prevention in uremic patients - Therapeutic strategies with particular attention to complete correction of renal anemia

Background: Left ventricular hypertrophy represents the major risk; factor for cardiac mortality and morbidity, with cardiac mortality being the most important determinant for survival in dialysis patients. The prevalence of left ventricular hypertrophy is already high at initiation of dialysis and increases with time. Anemia is considered as the most important factor for the development of left ventricular hypertrophy. Others already demonstrate d that with partial correction of renal anemia by erythropoietin a partial regression of the left ventricular mass can be achieved. Patients and metho ds: the investigated the effect of complete correction of renal anemia to n ormal hemoglobin values of 14 g/dl (Hct 42%) on left ventricular hypertroph y by echocardiography Eight Patients entered the study 4 - 8 weeks after in itiation of chronic hemodialysis with a mean hemoglobin of 9.5 +/- 1.3 g/dl ). Results: Left: ventricular mass index (LVMI) dereased from 155 +/- 45 g/ m(2) to 123 +/- 18g/m(2) (p < 0.05) within the observation period of 12 +/- 5 months. The results showed, that either normal left ventricular dimensio ns could be preserved or, if left ventricular hypertrophy was already prese nt, complete regression was possible. Conclusion. Therefore, we propose tha t complete correction of renal anemia should be introduced into the therapy of dialysis patients along with strict adherence to established measures f or the control of left ventricular hypertrophy: control of fluid overload a nd arterial hypertension and the use of ACE-inhibitors and betablockers. In addition, optimal correction of metabolic acidosis, control of the calcium -phosphate product and hyperparathyreoidism must be attempted. Thus, it sho uld be possible to reverse left ventricular hypertrophy and its deleterious consequences in the dialysis population in order to improve survival and q uality of life.