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J Am Soc Nephrol 15:148-156, 2004
© 2004 American Society of Nephrology

CLINICAL SCIENCE

Effects of Early and Late Intervention with Epoetin {alpha} on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4): Results of a Randomized Clinical Trial

Simon D. Roger*, Lawrence P. McMahon{dagger}, Anthony Clarkson{ddagger}, Alex Disney§, David Harris||, Carmel Hawley, Helen Healy#, Peter Kerr**, Kelvin Lynn{dagger}{dagger}, Alan Parnham{ddagger}{ddagger}, Roess Pascoe§§, David Voss||||, Robert Walker¶¶ and Adeera Levin##

*Department of Renal Medicine, Gosford Hospital, Gosford, Australia; {dagger}Departments of Nephrology, Western and Royal Melbourne Hospitals, Melbourne, Australia; {ddagger}Renal Unit, Royal Adelaide Hospital, Adelaide, Australia; §Renal Unit, Queen Elizabeth II Hospital, Adelaide, Australia; ||Department of Renal Medicine, Westmead Hospital, Westmead, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; #Department of Nephrology, Royal Brisbane Hospital, Brisbane, Australia; **Department of Nephrology, Monash Medical Centre, Clayton, Australia; {dagger}{dagger}Department of Nephrology, Christchurch Hospital, Christchurch, New Zealand; {ddagger}{ddagger}Department of Renal Medicine, Gold Coast Hospital, Surfers Paradise, Australia; §§Hearts 1st, Brisbane, Australia; ||||Department of Renal Medicine, Middlemore Hospital, New Zealand; ¶¶Department of Renal Medicine, Otago, New Zealand; and ##Education and Research Department, St. Paul’s Hospital, Vancouver, British Columbia, Canada.

Correspondence to Dr. Simon D. Roger, Department of Renal Medicine, Gosford Hospital, Gosford 2250, Australia. Phone: 61-2-43237977; Fax: 61-2-43252522;

ABSTRACT. It is not known whether prevention of anemia among patients with chronic kidney disease would affect the development or progression of left ventricular (LV) hypertrophy. A randomized controlled trial was performed with 155 patients with chronic kidney disease (creatinine clearance, 15 to 50 ml/min), with entry hemoglobin concentrations ([Hb]) of 110 to 120 g/L (female patients) or 110 to 130 g/L (male patients). Patients were monitored for 2 yr or until they required dialysis; the patients were randomized to receive epoetin {alpha} as necessary to maintain [Hb] between 120 and 130 g/L (group A) or between 90 and 100 g/L (group B). [Hb] increased for group A (from 112 ± 9 to 121 ± 14 g/L, mean ± SD) and decreased for group B (from 112 ± 8 to 108 ± 13 g/L) (P < 0.001, group A versus group B). On an intent-to-treat analysis, the changes in LV mass index for the groups during the 2-yr period were not significantly different (2.5 ± 20 g/m2 for group A versus 4.5 ± 20 g/m2 for group B, P = NS). There was no significant difference between the groups in 2-yr mean unadjusted systolic BP (141 ± 14 versus 138 ± 13 mmHg) or diastolic BP (80 ± 6 versus 79 ± 7 mmHg). The decline in renal function in 2 yr, as assessed with nuclear estimations of GFR, also did not differ significantly between the groups (8 ± 9 versus 6 ± 8 ml/min per 1.73 m2). In conclusion, maintenance of [Hb] above 120 g/L, compared with 90 to 100 g/L, had similar effects on the LV mass index and did not clearly affect the development or progression of LV hypertrophy. The maintenance of [Hb] above 100 g/L for many patients in group B might have been attributable to the relative preservation of renal function. E-mail: sroger@doh.health.nsw.gov.au; or Dr. Lawrence P. McMahon: lawrence.mcmahon@mh.org.au


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