Anaemia management and cardiomyopathy in renal failure

Patients with renal failure are at great cardiovascular risk, with attributable death rates 10-20 times those of an age-matched population. Most patients develop cardiomyopathy, with a continuum of left ventricular dilation (LV), hypertrophy and systolic dysfunction. Untreated, these conditions predispose to cardiac failure, a dominant and highly lethal cardiovascular syndrome in this population. Several prospective observational studies have demonstrated anaemia to be an independent risk factor for each step in the process: haemodynamic overload, maladaptive LV enlargement, LV burn-out and death. Recent evidence suggests that physiological haemoglobin targets (e.g. >12 g/dl) may be optimal for maintaining cardiac health and quality of life, especially in patients without pre-existing clinical cardiac disease. Ongoing studies should determine whether a physiologically targeted approach to anaemia management reduces the burden of cardiomyopathy in renal failure.