Does full versus partial correction of anemia have additional cardiac benefit in incident hemodialysis patients?

Anatole Besarab* and Sandeep Soman

This article has no abstract so we have provided the first paragraph of the full text.

Anemia is a major comorbidity in patients with end-stage renal disease (ESRD) on renal replacement therapies. We previously demonstrated a nonsignificant trend towards higher overall mortality in prevalent hemodialysis patients with clinical evidence of congestive heart failure or ischemic heart disease, when erythropoietin and iron supplementation were used to raise their hematocrit to 42%.¹ A previous study in prevalent hemodialysis patients with pre-existing left-ventricular abnormalities (the Canadian Normalization of Hemoglobin Trial), showed that normalization of hemoglobin did not lead to regression of established concentric left-ventricular hypertrophy or left-ventricular dilation; however, development of left-ventricular dilation was prevented.² Parfrey et al. now extend these investigations to patients of lower hemodialysis vintage (mean and maximum duration of dialysis 10 months and 18 months, respectively) without symptomatic heart disease or left-ventricular dilation. Any beneficial cardiac effects of correcting anemia in this population would be of great importance, because the burden of cardiovascular disease in patients with ESRD is extremely high; indeed, the incipient ESRD patient receiving renal replacement therapy is considered the highest cardiovascular risk patient in medicine.²

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