Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy

Background. Hemoglobin levels below 10 g/dL lead to left ventricular (LV) h ypertrophy, LV dilation, a lower quality of life, higher cardiac morbidity, and a higher mortality rate in end-stage renal disease. The benefits and r isks of normalizing hemoglobin levels in hemodialysis patients without symp tomatic cardiac disease are unknown. Methods. One hundred forty-six hemodialysis patients with either concentric LV hypertrophy or LV dilation were randomly assigned to receive doses of e poetin alpha designed to achieve hemoglobin levels of 10 or 13.5 g/dL. The study duration was 48 weeks. The primary outcomes were the change in LV mas s index in those with concentric LV hypertrophy and the change in cavity vo lume index in those with LV dilation. Results. In patients with concentric LV hypertrophy, the changes in LV mass index were similar in the normal and low target hemoglobin groups. The cha nges in cavity volume index were similar in both targets in the LV dilation group. Treatment-received analysis of the concentric LV hypertrophy group showed no correlation between the change in mass index and a correlation be tween the change in LV volume index and mean hemoglobin level achieved (8 m L/m(2) per 1 g/dL hemoglobin decrement, P = 0.009). Mean hemoglobin levels and the changes in LV mass and cavity volume index were not correlated in p atients with LV dilation. Normalization of hemoglobin led to improvements i n fatigue (P = 0.009), depression (P = 0.02), and relationships (P = 0.004) . Conclusions. Normalization of hemoglobin does not lead to regression of est ablished concentric LV hypertrophy or LV dilation. It may, however, prevent the development of LV dilation, and it leads to improved quality of life.