Anaemia in chronic renal disease: lessons learned since Seville 1994

Cardiovascular disease is the major cause of death among patients with end- stage renal disease, accounting for almost half of all fatalities. In recen t years much progress has been made in understanding the pathogenesis of ca rdiovascular disease in the uraemic population. Anaemia is a consistent fin ding in chronic renal disease, affecting up to 90%, of patients, and the ce ntral role of anaemia in the development of cardiovascular dysfunction is n ow well established. A significant proportion of patients have established cardiovascular complications on initiation of dialysis, raising the possibi lity of early correction of anaemia as a strategy for preventing cardiovasc ular co-morbidities among renal patients. Randomized, controlled trials hav e shown that normalization of haemoglobin (Hb) with recombinant erythropoie tin (rh-Epo) is of no cardiovascular benefit in haemodialysis patients with symptomatic heart failure, ischaemic heart disease, or severe left ventric ular dilatation, although suggestive evidence exists for benefits at earlie r stages of cardiac disease. Results from large-scale clinical trials are r equired to clarify the effects of early anaemia correction on mortality and cardiovascular function, as well as appropriate treatment targets in diffe rent patient populations. The potential exists for higher Hb levels to exte nd patient survival through cardioprotective effects.