STOCKHOLM — Treatment of anemia with erythropoietin in patients with chronic kidney disease prevented cardiac-function deterioration and heart failure in a randomized study with 31 patients.
These are the first findings to demonstrate that correcting anemia can prevent heart failure in patients with chronic kidney disease, said Dr. Konstantinos D. Pappas, who presented a poster at the annual congress of the European Society of Cardiology.
“Erythropoietin administration can prevent heart failure in patients with anemia and chronic kidney disease because it improves cardiac structure and function,” said Dr. Pappas, a cardiologist at University Hospital of Ioannina (Greece).
The study enrolled patients with early, predialysis-phase chronic kidney disease and no overt indications of cardiac disease. Of the 31 patients, 15 were randomized to receive 50 IU of erythropoietin/kg per week; if the patients' hemoglobin level rose above 13 g/L the dosage was scaled back to 25 IU/kg per week. The 16 patients who served as controls did not receive erythropoietin unless their hemoglobin level fell below 9 g/L.
Although erythropoietin is now routinely given to all patients with chronic kidney disease whose hemoglobin level falls below 12 g/L, that was not standard practice when the study began 2 years ago, Dr. Pappas said.
After a year of treatment, patients treated with erythropoietin had significant improvements compared with the placebo patients in a variety of clinical and cardiovascular measures, including creatinine clearance, reduced left ventricular mass, and improved left ventricular ejection fraction. Although these parameters all improved from baseline in the treated patients, they all deteriorated in those who did not receive routine erythropoietin, Dr. Pappas said.
Two measures in particular highlighted the improved outcomes of patients treated with erythropoietin.
The E/Em ratio, which represents left ventricular (diastolic) filling pressure and left ventricular compliance, fell from 10.9 at baseline to 9.7 after a year of erythropoietin treatment. Among control patients, the ratio rose from 11.1 at baseline to 14.8 after 1 year. The difference between the control and treated groups was statistically significant.
The Tei index, the myocardial performance index that represents global cardiac function, fell from 0.40 at baseline to 0.35 in the drug-treated patients, compared with a rise from 0.48 at baseline to 0.51 in the control patients, a statistically significant difference, compared with treated patients.