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Cardiac function and hematocrit level
J D Harnett1, G M Kent, R N Foley
1Division of Nephrology, Memorial University, St John's, Canada.
Insights
Anemia in dialysis patients significantly increases mortality risk and the likelihood of developing congestive heart failure. Early detection and management of anemia are crucial for improving outcomes in this population.
Area of Science:
- Nephrology
- Cardiology
- Hematology
Background:
- Patients undergoing dialysis face a significantly higher mortality rate compared to the general population, with cardiovascular disease being the primary cause.
- Anemia is a common complication in patients on dialysis, often associated with poor clinical outcomes.
Purpose of the Study:
- To investigate the independent association between anemia and mortality in patients on dialysis.
- To determine if anemia predicts the occurrence and recurrence of congestive heart failure in this cohort.
- To identify risk factors for left ventricular hypertrophy (LVH) in end-stage renal disease (ESRD) patients.
Main Methods:
- Prospective cohort study involving 433 patients across three dialysis centers.
- Follow-up duration averaged 41 months.
- Cox's regression modeling was employed to assess the independent predictive value of hemoglobin levels on mortality and heart failure, controlling for various clinical and echocardiographic factors.
Main Results:
- Anemia independently predicted mortality (RR 1.18 per 1.0 g/dL decrease in hemoglobin).
- Anemia was also an independent predictor of new-onset congestive heart failure (RR 1.49), heart failure at dialysis initiation (RR 1.14), and heart failure recurrence (RR 1.25).
- Increasing age, hypertension, and anemia were identified as risk factors for left ventricular hypertrophy, which itself independently predicts mortality.
Conclusions:
- Anemia is a significant independent risk factor for mortality and congestive heart failure in patients on dialysis.
- Management of anemia may be critical for improving cardiovascular outcomes in ESRD patients.
- Recombinant human erythropoietin (epoetin) has shown potential in improving left ventricular mass in some studies.
Abstract:
Patients on dialysis have an age-adjusted death rate 3.5 times that of the general population. The most common cause of death in patients on dialysis is cardiovascular disease. We prospectively followed a cohort of 433 patients in three centers for a mean of 41 months. Mean hemoglobin level at the beginning of dialysis was 8.39 (+/- 1.7) g/dL, and the mean hemoglobin level during follow-up was 8.84 (+/- 1.5) g/dL. Using Cox's regression model, we found that anemia predicted mortality independently of age, diabetes mellitus, cardiac failure, hypoalbuminemia, serum creatinine, mean arterial pressure, or echocardiographic heart disease. The independent relative risk (RR) of mortality was 1.18 per 1.0 g/dL decrease in hemoglobin level. Anemia also independently predicted the de novo occurrence of congestive heart failure when the same covariates were controlled for (RR, 1.49 per 1.0 g/dL decrease). Anemia was also independently predictive of heart failure at the start of dialysis (RR, 1.14 per 1.0 g/dL decrease) and heart failure recurrence (RR, 1.25 per 1.0 g/dL decrease). Left ventricular hypertrophy is present in 75% of patients on dialysis at the start of therapy for end-stage renal disease. It independently predicts mortality. Our prospective cohort study identified increasing age, hypertension, and anemia as risk factors for its development. One controlled study and several uncontrolled studies demonstrated improvement (but not complete regression) of elevated left ventricular mass in patients on dialysis treated with recombinant human erythropoietin (epoetin).