Proven strategies to reduce cardiovascular mortality in hemodialysis patients.
Blood Purif
; 24(1): 100-6, 2006.
Article
en En
| MEDLINE
| ID: mdl-16361849
ABSTRACT
BACKGROUND:
In hemodialysis patients, left ventricular hypertrophy (LVH) correlates with mortality. The reason for LVH in uremics is multifactorial. The primary objective of our study was to investigate the effects of a multi-interventional treatment strategy on LVH.METHODS:
In 230 ambulatory patients, including patients with coronary artery disease, diabetes, diastolic and systolic dysfunction, we continued optimized cardiac therapy (beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) with full anemia correction by intravenous epoetin-beta. The dose of epoetin-beta for maintaining target hemoglobin (Hb) was 68 +/- 23 IU/kg/week. Serial echocardiograms were recorded every 3-6 months. The mean observation period was 4.8 +/- 1.2 years.RESULTS:
Mean Hb at baseline was 11.2 +/- 2.0 versus 14.1 +/- 1.4 g/dl (p < 0.001) at study end. There was a significant reduction in left ventricular mass index (LVMI 159 +/- 50.4 vs. 130.2 +/- 42.7 g/m(2); p < 0.001). In a subgroup of 2/3 of the patients, LVMI returned to normal (169 +/- 33 vs. 114 +/- 14 g/m2; p < 0.001).CONCLUSION:
Baseline LVMI (p < 0.001), Hb increase (p < 0.03), and triple cardiac therapy (p < 0.03) were significant and independent prognostic factors for a reduction in LVMI. The annual cardiovascular mortality was 5%. Even anemia correction from 12 to 14 g/dl results in further (p < 0.001) regression of LVMI.
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Base de datos:
MEDLINE
Asunto principal:
Uremia
/
Inhibidores de la Enzima Convertidora de Angiotensina
/
Eritropoyetina
/
Diálisis Renal
/
Hipertrofia Ventricular Izquierda
/
Bloqueadores del Receptor Tipo 1 de Angiotensina II
/
Anemia
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
Idioma:
En
Revista:
Blood Purif
Año:
2006
Tipo del documento:
Article