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

Kai-Uwe Eckardt^*, Armin Scherhag, Iain C. Macdougall, Dimitrios Tsakiris^||, Naomi Clyne^¶, Francesco Locatelli^**, Michael F. Zaug, Hans U. Burger and Tilman B. Drueke

^* Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany;
Pharmaceutical Division, F. Hoffmann-La Roche, Basel, Switzerland;
Medical Clinic, Mannheim University Hospital, University of Heidelberg, Heidelberg, Germany;
Department of Renal Medicine, King’s College Hospital, London, United Kingdom;
^|| Department of Nephrology, General Hospital of Veria, Veria, Greece;
^¶ Department of Nephrology, University Hospital of Lund, Lund, Sweden;
^** Department of Nephrology, Dialysis and Renal Transplantation, Ospedale A. Manzoni, Lecco, Italy; and
INSERM Research Unit 507 and Division of Nephrology, Necker Hospital, Paris, France

Correspondence: Dr. Kai-Uwe Eckardt, Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany. Phone: +49-9131-85-39002; Fax: +49-9131-85-39209; E-mail: med4{at}uk-erlangen.de

Received for publication June 18, 2009. Accepted for publication September 1, 2009.

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.

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673