Related Experiment Videos

Italian randomized trial of hemoglobin maintenance to prevent or delay left ventricular hypertrophy in chronic kidney

Bruno Cianciaruso1, Pietro Ravani, Brendan J Barrett

  • 1Division of Nephrology, Faculty of Medicine, University "Federico II" of Naples, Naples - Italy. cianciar@unina.it

Journal of Nephrology
|November 27, 2008
PubMed

Insights

This study found that targeting normal hemoglobin levels in chronic kidney disease patients did not significantly slow left ventricular growth. This suggests that aiming for normal hemoglobin may not benefit CKD patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Hematology

Background:

  • Chronic kidney disease (CKD) patients often experience anemia, impacting cardiac health.
  • Left ventricular (LV) growth is a concern in CKD, potentially exacerbated by anemia.
  • This study investigated the effect of normal hemoglobin levels on LV growth in non-dialyzed CKD patients.

Purpose of the Study:

  • To determine if maintaining normal hemoglobin levels delays left ventricular growth in CKD patients.
  • To assess the efficacy of epoetin-alpha in managing hemoglobin and LV mass in CKD.

Main Methods:

  • An open-label, randomized, multicenter controlled trial in Italy involving 95 CKD patients.
  • Treated group (n=46) received epoetin-alpha to maintain hemoglobin 12-14 g/dL; control group (n=49) received treatment only if hemoglobin dropped below 9.0 g/dL.
  • Primary endpoint was LV mass index (MI) change at 24 months, with a 12-month analysis due to early termination.

Main Results:

  • Hemoglobin levels significantly increased in the treated group (12.4 g/L) versus controls (11.3 g/L; p<0.001).
  • No significant change in LV mass index was observed in either the control or the epoetin-alpha treated group.
  • The study was limited by power, follow-up duration, and baseline LVMI in some participants.

Conclusions:

  • The Italian trial did not demonstrate a benefit of targeting normal hemoglobin levels for reducing LV growth in CKD patients.
  • Results were consistent with other studies, suggesting limited benefit of this therapeutic approach.
  • Further research may be needed, but current evidence indicates it's unlikely that targeting normal hemoglobin benefits CKD patients.
Abstract

Related Concept Videos

Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
Chronic Kidney Disease IV: Nursing Management01:18

Chronic Kidney Disease IV: Nursing Management

Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of fluid...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...