Optimized heart failure therapy and complete anemia correction on left-ventricular hypertrophy in nondiabetic and diabetic patients undergoing hemodialysis

Kidney Blood Press Res. 2005;28(5-6):353-62. doi: 10.1159/000090190. Epub 2006 Mar 7.

Abstract

Background: According to new guidelines, diabetes mellitus per se can be considered as stage I chronic heart failure (CHF). Available evidence suggests that patients suffering from both diabetes mellitus and renal insufficiency have disproportionately high rates of left-ventricular hypertrophy (LVH).

Methods: Optimized heart failure therapy, including beta-blockers, ACE-inhibitors and AT II-type-1-receptor-blockers, was prescribed in combination with complete anemia correction using epoetin beta (target hemoglobin: 13.5 g/dl for women; 14.5 g/dl for men) to 230 patients (55% male) with ambulatory hemodialysis, including 60 patients (52% male) with diabetes. Echocardiographic follow-up examinations were performed over a mean period of 4.4 +/- 1.2 years.

Results: Mean hemoglobin levels at the study end significantly increased to target levels in the entire study population and in patients with diabetes (both p < 0.001). Compared with baseline, significant improvements were seen in hemodialysis patients - both without and with diabetes - in left-ventricular mass index (-28.8 g/m2 [p < 0.001] and 29.0 g/m2 [p < 0.005], respectively), left-ventricular ejection fraction (+7.0% [p < 0.001] and +8.3% [p < 0.01], respectively) and in NYHA class (-0.84 [p < 0.01] and -1.12 [p < 0.01], respectively). Similar to the results in the overall population, a highly significant reduction in LVH (p < 0.005) and significant improvements in LVEF (p < 0.01) and NYHA class (p < 0.01) were seen in the high-risk subgroup of diabetic patients.

Conclusions: Patients undergoing hemodialysis, with or without concomitant diabetes, benefit considerably from optimized, multifactorial heart failure therapy combined with complete anemia correction.

MeSH terms

  • Acid-Base Equilibrium / physiology
  • Aged
  • Anemia / etiology
  • Anemia / therapy*
  • Blood Pressure / physiology
  • Body Mass Index
  • Diabetic Nephropathies / therapy*
  • Endpoint Determination
  • Female
  • Heart Failure / etiology
  • Heart Failure / therapy*
  • Hemodynamics / physiology
  • Humans
  • Hypertrophy, Left Ventricular / etiology
  • Hypertrophy, Left Ventricular / pathology
  • Hypertrophy, Left Ventricular / therapy*
  • Iron / blood
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Myocardial Infarction / physiopathology
  • Renal Dialysis
  • Survival Rate

Substances

  • Iron