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Left Ventricular Geometry Predicts Cardiovascular Outcomes Associated with Anemia Correction in CKD

Eckardt, Kai-Uwe; Scherhag, Armin; Macdougall, Iain C.; Tsakiris, Dimitrios; Clyne, Naomi LU ; Locatelli, Francesco; Zaug, Michael F.; Burger, Hans U. and Drueke, Tilman B. (2009) In Journal of the American Society of Nephrology 20(12). p.2651-2660
Abstract
Partial correction of anemia in patients with chronic kidney disease (CKD) reduces left ventricular hypertrophy (LVH), which is a risk factor for cardiovascular (CV) morbidity, but complete correction of anemia does not improve CV outcomes. Whether LV geometry associates with CV events in patients who are treated to different hemoglobin (Hb) targets is unknown. One of the larger trials to study the effects of complete correction of anemia in stages 3 to 4 CKD was the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial. Here, we analyzed echocardiographic data from CREATE to determine the prevalence, dynamics, and prognostic implications of abnormal LV geometry in patients who were treated to different... (More)
Partial correction of anemia in patients with chronic kidney disease (CKD) reduces left ventricular hypertrophy (LVH), which is a risk factor for cardiovascular (CV) morbidity, but complete correction of anemia does not improve CV outcomes. Whether LV geometry associates with CV events in patients who are treated to different hemoglobin (Hb) targets is unknown. One of the larger trials to study the effects of complete correction of anemia in stages 3 to 4 CKD was the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial. Here, we analyzed echocardiographic data from CREATE to determine the prevalence, dynamics, and prognostic implications of abnormal LV geometry in patients who were treated to different Hb targets. The prevalence of LVH at baseline was 47%, with eccentric LVH more frequent than concentric. During the study, LVH prevalence and mean left ventricular mass index did not change significantly, but LV geometry fluctuated considerably within 2 yr in both groups. CV event-free survival was significantly worse in the presence of concentric LVH and eccentric LVH compared with the absence of LVH (P = 0.0009 and P <= 0.0001, respectively). Treatment to the higher Hb target associated with reduced event-free survival in the subgroup with eccentric LVH at baseline (P = 0.034). In conclusion, LVH is common and associates with poor outcomes among patients with stages 3 to 4 CKD, although both progression and regression of abnormal LV geometry occur. Complete anemia correction may aggravate the adverse prognosis of eccentric LVH. (Less)
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Contribution to journal
publication status
published
subject
in
Journal of the American Society of Nephrology
volume
20
issue
12
pages
2651 - 2660
publisher
American Society of Nephrology
external identifiers
  • wos:000272637400023
  • scopus:72049089062
ISSN
1046-6673
DOI
10.1681/ASN.2009060631
language
English
LU publication?
yes
id
76cc127d-1a09-48da-ab14-ec69cc4d6444 (old id 1532688)
date added to LUP
2010-01-29 10:02:57
date last changed
2017-12-10 04:04:08
@article{76cc127d-1a09-48da-ab14-ec69cc4d6444,
  abstract     = {Partial correction of anemia in patients with chronic kidney disease (CKD) reduces left ventricular hypertrophy (LVH), which is a risk factor for cardiovascular (CV) morbidity, but complete correction of anemia does not improve CV outcomes. Whether LV geometry associates with CV events in patients who are treated to different hemoglobin (Hb) targets is unknown. One of the larger trials to study the effects of complete correction of anemia in stages 3 to 4 CKD was the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial. Here, we analyzed echocardiographic data from CREATE to determine the prevalence, dynamics, and prognostic implications of abnormal LV geometry in patients who were treated to different Hb targets. The prevalence of LVH at baseline was 47%, with eccentric LVH more frequent than concentric. During the study, LVH prevalence and mean left ventricular mass index did not change significantly, but LV geometry fluctuated considerably within 2 yr in both groups. CV event-free survival was significantly worse in the presence of concentric LVH and eccentric LVH compared with the absence of LVH (P = 0.0009 and P &lt;= 0.0001, respectively). Treatment to the higher Hb target associated with reduced event-free survival in the subgroup with eccentric LVH at baseline (P = 0.034). In conclusion, LVH is common and associates with poor outcomes among patients with stages 3 to 4 CKD, although both progression and regression of abnormal LV geometry occur. Complete anemia correction may aggravate the adverse prognosis of eccentric LVH.},
  author       = {Eckardt, Kai-Uwe and Scherhag, Armin and Macdougall, Iain C. and Tsakiris, Dimitrios and Clyne, Naomi and Locatelli, Francesco and Zaug, Michael F. and Burger, Hans U. and Drueke, Tilman B.},
  issn         = {1046-6673},
  language     = {eng},
  number       = {12},
  pages        = {2651--2660},
  publisher    = {American Society of Nephrology},
  series       = {Journal of the American Society of Nephrology},
  title        = {Left Ventricular Geometry Predicts Cardiovascular Outcomes Associated with Anemia Correction in CKD},
  url          = {http://dx.doi.org/10.1681/ASN.2009060631},
  volume       = {20},
  year         = {2009},
}