Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD Patients

Parfrey, Patrick S.; Lauve, Maria; Latrémouille-Viau, Dominick; Lefèbvre, Patrick

doi:10.2215/cjn.02730608

Cited by 109 publications

(80 citation statements)

References 34 publications

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“…Left-ventricular mass is a strong predictor of cardiovascular risk in dialysis patients, but unlike in the hypertensive population, regression does not necessarily portend improved outcomes; harm associated with complete correction of anemia is a case in point. [13][14][15][16][17] Even if left-ventricular mass regression were to reduce the risk of major adverse cardiovascular events, the magnitude of mortality risk reduction would likely be ,39%. 18 In addition, nonrandomized studies of frequent hemodialysis may elicit skepticism, because selection of appropriate controls is not straightforward.…”

Section: Discussionmentioning

confidence: 99%

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Weinhandl

Liu

Gilbertson

et al. 2012

Journal of the American Society of Nephrology

192

171

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Frequent hemodialysis improves cardiovascular surrogates and quality-of-life indicators, but its effect on survival remains unclear. We used a matched-cohort design to assess relative mortality in daily home hemodialysis and thrice-weekly in-center hemodialysis patients between 2005 and 2008. We matched 1873 home hemodialysis patients with 9365 in-center patients (i.e., 1:5 ratio) selected from the prevalent population in the US Renal Data System database. Matching variables included first date of follow-up, demographic characteristics, and measures of disease severity. The cumulative incidence of death was 19.2% and 21.7% in the home hemodialysis and in-center patients, respectively. In the intention-to-treat analysis, home hemodialysis associated with a 13% lower risk for all-cause mortality than in-center hemodialysis (hazard ratio [HR], 0.87; 95% confidence interval [95% CI], 0.78-0.97). Cause-specific mortality HRs were 0.92 (95% CI, 0.78-1.09) for cardiovascular disease, 1.13 (95% CI, 0.84-1.53) for infection, 0.63 (95% CI, 0.41-0.95) for cachexia/dialysis withdrawal, 1.06 (95% CI, 0.81-1.37) for other specified cause, and 0.59 (95% CI, 0.44-0.79) for unknown cause. Findings were similar using as-treated analyses. We did not detect statistically significant evidence of heterogeneity of treatment effects in subgroup analyses. In summary, these data suggest that relative to thrice-weekly in-center hemodialysis, daily home hemodialysis associates with modest improvements in survival. Continued surveillance should strengthen inference about causes of mortality and determine whether treatment effects are homogeneous throughout the dialysis population.

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Section: Discussionmentioning

confidence: 99%

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Weinhandl

Liu

Gilbertson

et al. 2012

Journal of the American Society of Nephrology

192

171

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“…Parfrey et al (82) recently reported on a meta-analysis of 15 unique, nonoverlapping trials (5 of which were randomized and controlled) involving 1731 subjects. LV mass was reduced by anemia correction by EPO administration only in those subjects who had severe anemia at baseline (Ͻ10 g hemoglobin/dl) and who were treated to a lower target hemoglobin level (Յ12 g hemoglobin/dl).…”

Section: What Are the Key Principles Of Management Of Lvh In Ckd And mentioning

confidence: 99%

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Glassock

Pecoits‐Filho

Barberato

2009

Clinical Journal of the American Society of Nephrology

325

279

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Chronic kidney disease (CKD) and ESRD, treated with conventional hemo-or peritoneal dialysis are both associated with a high prevalence of an increase in left ventricular mass (left ventricular hypertrophy [LVH]), intermyocardial cell fibrosis, and capillary loss. Cardiac magnetic resonance imaging is the best way to detect and quantify these abnormalities, but M-Mode and 2-D echocardiography can also be used if one recognizes their pitfalls. The mechanisms underlying these abnormalities in CKD and ESRD are diverse but involve afterload (arterial pressure and compliance), preload (intravascular volume and anemia), and a wide variety of afterload/preload independent factors. The hemodynamic, metabolic, cellular, and molecular mediators of myocardial hypertrophy, fibrosis, apoptosis, and capillary degeneration are increasingly well understood. These abnormalities predispose to sudden cardiac death, most likely by promotion of electrical instability and re-entry arrhythmias and congestive heart failure. Current treatment modalities for CKD and ESRD, including thrice weekly conventional hemodialysis and peritoneal dialysis and metabolic and anemia management regimens, do not adequately prevent or correct these abnormalities. A new paradigm of therapy for CKD and ESRD that places prevention and reversal of LVH and cardiac fibrosis as a high priority is needed. This will require novel approaches to management and controlled interventional trials to provide evidence to fuel the transition from old to new treatment strategies. In the meantime, key management principles designed to ameliorate LVH and its complications should become a routine part of the care of the patients with CKD and ESRD.

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“…Perhaps augmented gastrointestinal elimination of salt through orally administered exchange resins may help control inter-and intradialytic ECFV. Treatment of anemia has little effect on LV hypertrophy except when hemoglobin values are Ͻ10 g/dl (36).…”

Section: Disease Salt and Volumementioning

confidence: 99%

Dialysis at a Crossroads

Parker

Hakim

Nissenson³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryThe ability to offer repetitive hemodialysis for treatment of chronic kidney failure has now reached its halfcentury anniversary. Although millions of patients have benefited from this life-extending procedure, current results in the United States have now stagnated with only small annual improvements in survival and continued high hospitalization rates. Recognition that this stagnation may be, at least in part, the result of inadequacies of current and prior paths utilized in dialysis treatment has led to the concept that dialysis therapy is at a crossroads and that new paths need to be articulated, explored, and applied. This article proposes some of these new paths and their rationale. Two elements of the new paths are emphasized: avoidance of indwelling catheters for vascular access and meticulous attention to control of extracellular volume and mitigation of left ventricular hypertrophy and fibrosis. It is postulated that progress in these two areas, along with continued attention to other elements embodied in the new and old paths, will unlock the stagnation in outcomes of dialysis therapy of end-stage kidney failure and allow it to realize its full potential of prolonging life and alleviating disability.

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Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD Patients

Cited by 109 publications

References 34 publications

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Survival in Daily Home Hemodialysis and Matched Thrice-Weekly In-Center Hemodialysis Patients

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Dialysis at a Crossroads

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