RESUMO
OBJECTIVE: Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in dialysis patients. It remains unclear whether efforts to correct anemia in patients with mild-to-moderate chronic renal insufficiency (CRI) can reverse LVH. This prospective multi-center Chinese cohort study evaluates left ventricular mass index (LVMI) evolution in anemic CRI patients with or without recombinant human erythropoietin (rHuEPO) therapy. METHODS: Six centers enrolled 158 patients with serum creatinine from 147 to 400 micromol/L, and 86 of whom with hemoglobin (Hb) levels < 110 g/L received rHuEPO (Group A). Forty patients with comparable Hb levels (< 110 g/L) but did not receive rHuEPO (Group B) and those with Hb >/= 110 g/L (Group C, n = 32) were served as controls. Echocardiographic studies were performed to evaluate LVMI at baseline and every 3 months during a two-year period. RESULTS: At baseline, the prevalence of LVH was 72.1% in Group A, 72.5% in Group B and 59.4% in Group C. LVMI was inversely correlated with Hb levels (r = -0.70, P < 0.01). There was no difference in age, gender, aetiology of renal failure, blood pressure (BP) and cardiovascular risk factors between the 3 groups. The administration of rHuEPO in Group A significantly increased Hb levels from (93.8 +/- 14.6) g/L to (111.2 +/- 10.3) g/L and decreased LVMI from (142.6 +/- 25.7) g/m(2) to (132.4 +/- 18.5) g/m(2). The prevalence of LVH decreased 16.3% after a partial correction of anemia at 24 months, whereas Hb levels in controls (Group B and Group C) tended to decrease and LVMI significantly increased compared with baseline. The prevalence of LVH was significantly increased in Group B and C after 24 months. The percentage of patients whose serum creatinine level doubled during the follow-up was 3.4% in Group A, 15.0% in Group B and 9.4% in Group C, the difference between Group A and Group B being significant (P < 0.05). In addition, good BP control was obtained without any adverse effects. CONCLUSION: High prevalence of LVH was present in pre-dialysis CRI patients, which is associated with severity of anemia. Early treatment of anemia with rHuEPO can reverse LVH in CRI patients.