Impact of anaemia treatment for left ventricular remodelling prior to initiation of dialysis in chronic kidney disease patients: Efficacy and stability of long acting erythropoietin stimulating agents

Io, Hiroaki; Aizawa, Masashi; Funabïki, Kazuhiko; Horikoshi, Satoshi; Tomino, Yasuhiko

doi:10.1111/nep.12640

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…The association between AVF flow volume and LVH has been suspected for a long time. Movilli et al (20) documented a decrease of the left ventricular mass after AVF closure (20) – an effect similar to anemia therapy by erythropoietin (21).…”

Section: Left Ventricular Hypertrophymentioning

confidence: 97%

Heart disease in chronic kidney disease – review of the mechanisms and the role of dialysis access

Malík

2018

J Vasc Access

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REVIEW misinterpreted as pure overhydration and vice versa. Various attempts to emphasize the role of heart disease in chronic kidney disease (CKD) patients have been published-from the well-known cardiorenal syndrome classification by Ronco et al (2) to the recent conclusions of the Acute Dialysis Quality Initiative XI Workgroup (3), which proposed a new classification of heart failure in ESRD patients. The latter workgroup specifically excludes patients with simple water overload and a normal heart, and focuses on those having specific echocardiographical changes. These include 3 elements: (i) ECHO evidence of structural or functional heart abnormalities; (ii) shortness of breath occurring in the absence of pulmonary disease; and (iii) the response of congestive symptoms to ultrafiltration (3). The same group (4) selected the following 8 echocardiographic criteria of structural heart disease; it is present if at least 1 criterion is detected (see Tab. I). Although this attempt to standardize the definition of structural heart disease in ESRD patients is respectable, some important issues were missed, such as pulmonary hypertension, lack of any cardiac calcification score, and the presence of significant coronary artery disease. Moreover, their cutoff values for various pathological findings differ from the European and American guidelines for echocardiography (Tab. I). The particular pathological changes are noted below. Arterial disease Characteristics Patients suffering from ESRD are also affected by accelerated atherosclerosis (disease of the intimal arterial wall layer) and from medial calcinosis. Etiopathogenesis Atherogenesis is accelerated due to the higher occurrence of traditional risk factors: diabetes mellitus, arterial hypertension, changes of serum lipids, plus the uremic millieu interieur Heart disease in chronic kidney diseasereview of the mechanisms and the role of dialysis access

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Section: Left Ventricular Hypertrophymentioning

confidence: 97%

Heart disease in chronic kidney disease – review of the mechanisms and the role of dialysis access

Malík

2018

J Vasc Access

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“…In this study, the Hb level reached the target value. For such cases, aggressive treatment (nephrologist follow-up; patients with a history of nephropathy treatment) is considered necessary [ 8 ]. In an observational study, the conversion from epoetin beta to epoetin beta pegol maintained a Hb level between 11.2 g/dl and 11.4 g/dl after 12 months [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Renal anemia is a common complication in patients with CKD (p-CKDs) [ 7 ]; it usually develops because of erythropoietin deficiency. In a previous study, the mean hemoglobin (Hb) value was found to be higher in an LVH-uncomplicated group than in an LVH-combined group from the pre-dialysis to dialysis initiation period when using long-acting erythropoietin-stimulating agents (L-ESAs) [ 8 ]. However, few longitudinal analyses have evaluated the factors associated with LVMI.…”

Section: Introductionmentioning

confidence: 99%

Impact of anemia treatment for left ventricular hypertrophy using long-acting erythropoietin-stimulating agents from the pre-dialysis to maintenance dialysis period in patients with chronic kidney disease, retrospective longitudinal cohort study

Muto

Sasaki

et al. 2023

BMC Nephrol

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Background Anemia in patients with chronic kidney disease (p-CKDs) may initiate or exacerbate left ventricular hypertrophy (LVH). This study aimed to determine whether treatment using long-acting erythropoietin-stimulating agents (L-ESAs) is independently associated with LVH during the pre-dialysis to maintenance dialysis period in p-CKDs. Methods Physical and laboratory examinations were performed 120 days before initiating dialysis in p-CKDs (baseline). To evaluate the left ventricular mass index (LVMI) after starting dialysis, the mean hemoglobin (Hb) was defined as the average at the start of dialysis and 6 months after starting dialysis. Changes in the LVMI were observed in three groups according to mean Hb levels (Hb < 10.1, 10.1 < Hb < 11.0, and Hb > 11.0 g/dL for Groups 1, 2, and 3, respectively). LVMI was evaluated using echocardiography at the pre-dialysis, initiation, and maintenance dialysis periods. Results A lower LVMI at dialysis initiation and an improvement in LVMI were detected in the highest tertile group of mean Hb (11.0 g/dl). Consequently, in the high Hb group (Hb level > 11.0 g/dl), LVMI remained low from dialysis initiation until after 6 months.The relationship between Hb and LVMI was not significant; however, a constant correlation with β ≥ 0.4 in the absolute value was maintained. Conclusion L-ESAs may correlate with Hb and LVMI after administration, independent of the baseline LVMI and Hb values. These findings have therapeutic implications in the treatment strategies for p-CKDs during the pre-dialysis to maintenance dialysis period.

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“…Ozkahya et al report that the volume decrease in dialysis patients can achieve reasonable long-term BP control and decreased LVMI [ 23 ]. Secondly, elevated HGB also affects reducing LVMI [ 24 ]. Furthermore, better phosphorus control is also a benefit for the decreased prevalence of LVH [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Regression of Left Ventricular Hypertrophy in Patients Combined with Peritoneal Dialysis and Hemodialysis

Gao

Zhang

Feng

et al. 2022

International Journal of Clinical Practice

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Background/Aims. Combined peritoneal dialysis and hemodialysis (PHD) are used in treating PD patients who underwent technique failure. This study aimed to research the cardiac structural and functional change in patients before and after PHD. Methods. This retrospective study enrolled 58 patients at The Second Affiliated Hospital of Soochow University who switched from PD to PHD. Clinical data and echocardiographic examination results were collected. Data from the two groups with a normal distribution were compared with the paired t-test. A p value <0.05 (two-tailed) was considered statistically significant. Results. A total of 58 subjects were enrolled, including 46 males and 12 females, with a median age of 50.2 ± 11.1 (47–68) years. The mean duration of peritoneal dialysis was 67.2 ± 33.6 months. Before and after PHD, the ultrafiltration volume ( p = 0.021) and hemoglobin ( p = 0.001) were increased, while SBP ( p = 0.002), DBP ( p = 0.002), phosphorus ( p < 0.001), and ESA dosage ( p < 0.001) were decreased. Before and after combined dialysis (PHD), the incidence of LVH was 76.4% and 61.8%, respectively ( p = 0.013), and LVMI decreased from 173.8 ± 86.2 g/m2 to 160.6 ± 78.5 g/m2 ( p < 0.001). Conclusion. Compared with PD alone, the combination of PD and HD resulted in regression of LVH and reduced LVMI.

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Impact of anaemia treatment for left ventricular remodelling prior to initiation of dialysis in chronic kidney disease patients: Efficacy and stability of long acting erythropoietin stimulating agents

Abstract: Long-acting ESA was effective and stable when treating anaemia until the start of dialysis. It is important to treat anaemia for the prevention of LV remodelling in CKD patients. These findings have some therapeutic implications for treatment strategies for pre-dialysis patients.

Cited by 7 publications

References 25 publications

Heart disease in chronic kidney disease – review of the mechanisms and the role of dialysis access

Heart disease in chronic kidney disease – review of the mechanisms and the role of dialysis access

Impact of anemia treatment for left ventricular hypertrophy using long-acting erythropoietin-stimulating agents from the pre-dialysis to maintenance dialysis period in patients with chronic kidney disease, retrospective longitudinal cohort study

Regression of Left Ventricular Hypertrophy in Patients Combined with Peritoneal Dialysis and Hemodialysis

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