Long-acting erythropoietin-stimulating agents (ESAs) effectively treat anemia in chronic kidney disease (CKD) patients until the start of dialysis, according to a new study. Improving anemia, in turn, appears to prevent the remodeling that leads to left ventricular hypertrophy (LVH), a potent risk factor for cardiovascular events and early death.
Hiroaki Io, MD, of Juntendo University Faculty of Medicine in Tokyo, and colleagues reviewed clinical, laboratory, and urinary results from 27 CKD patients who had received either monthly long-acting or short-acting ESAs prior to dialysis initiation. None received supplemental iron.
Those who took long-acting ESAs showed greater improvement in erythropoietin resistance, according to findings published online ahead of print in Nephrology. More research is needed to determine a safe upper limit of hemoglobin in anemic CKD patients.
The investigators further determined that left ventricular mass (LVM) index (assessed by echocardiography) was associated with use of long-acting ESAs, average hemoglobin levels, and hemoglobin level at dialysis initiation. Patients with the highest average hemoglobin levels (10.4 g/dL) had the greatest improvement in LVM. Albumin, urinary protein, blood pressure, and brain natriuretic peptide, by contrast, showed no association.
“Our study showed that treatment of anemia should prevent LVH,” the researchers explained. “Interestingly, the LV geometry pattern, and not just the presence of an elevated LV mass, appears to be important in predicting response to the correction of anemia in CKD.”
Study patients had a large level of the concentric LVH pattern, they noted. Studies have shown that eccentric versus concentric hypertrophy is a risk factor for poor cardiovascular outcomes and worsening renal function in anemic CKD patients.