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  • S. Karger AG  (2)
  • Gogoll, Lutz  (2)
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  • S. Karger AG  (2)
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  • 1
    Online Resource
    Online Resource
    Optimized Heart Failure Therapy and Complete Anemia Correction on Left-Ventricular Hypertrophy in Nondiabetic and Diabetic Patients Undergoing Hemodialysis
    S. Karger AG ; 2005
    In:  Kidney and Blood Pressure Research Vol. 28, No. 5-6 ( 2005), p. 353-362
    Details
    In: Kidney and Blood Pressure Research, S. Karger AG, Vol. 28, No. 5-6 ( 2005), p. 353-362
    Abstract: 〈 i 〉 Background: 〈 /i 〉 According to new guidelines, diabetes mellitus 〈 i 〉 per se 〈 /i 〉 can be considered as stage I chronic heart failure (CHF). Available evidence suggests that patients suffering from both diabetes mellitus and renal insufficiency have disproportionately high rates of left-ventricular hypertrophy (LVH). 〈 i 〉 Methods: 〈 /i 〉 Optimized heart failure therapy, including β-blockers, ACE-inhibitors and AT II-type-1-receptor-blockers, was prescribed in combination with complete anemia correction using epoetin beta (target hemoglobin: 13.5 g/dl for women; 14.5 g/dl for men) to 230 patients (55% male) with ambulatory hemodialysis, including 60 patients (52% male) with diabetes. Echocardiographic follow-up examinations were performed over a mean period of 4.4 ± 1.2 years. 〈 i 〉 Results: 〈 /i 〉 Mean hemoglobin levels at the study end significantly increased to target levels in the entire study population and in patients with diabetes (both p 〈 0.001). Compared with baseline, significant improvements were seen in hemodialysis patients – both without and with diabetes – in left-ventricular mass index (–28.8 g/m 〈 sup 〉 2 〈 /sup 〉 [p 〈 0.001] and 29.0 g/m 〈 sup 〉 2 〈 /sup 〉 [p 〈 0.005], respectively), left-ventricular ejection fraction (+7.0% [p 〈 0.001] and +8.3% [p 〈 0.01], respectively) and in NYHA class (–0.84 [p 〈 0.01] and –1.12 [p 〈 0.01], respectively). Similar to the results in the overall population, a highly significant reduction in LVH (p 〈 0.005) and significant improvements in LVEF (p 〈 0.01) and NYHA class (p 〈 0.01) were seen in the high-risk subgroup of diabetic patients. 〈 i 〉 Conclusions: 〈 /i 〉 Patients undergoing hemodialysis, with or without concomitant diabetes, benefit considerably from optimized, multifactorial heart failure therapy combined with complete anemia correction.
    Type of Medium: Online Resource
    ISSN: 1420-4096 , 1423-0143
    URL: Article
    DOI: 10.1159/000090190
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2005
    detail.hit.zdb_id: 1482922-8
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  • 2
    Online Resource
    Online Resource
    Effects of Optimized Heart Failure Therapy and Anemia Correction with Epoetin β on Left Ventricular Mass in Hemodialysis Patients
    S. Karger AG ; 2005
    In:  American Journal of Nephrology Vol. 25, No. 3 ( 2005), p. 211-220
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 25, No. 3 ( 2005), p. 211-220
    Abstract: 〈 i 〉 Background: 〈 /i 〉 In chronic hemodialysis (HD) patients, the presence and degree of left ventricular hypertrophy (LVH) correlates with mortality. Previous studies have shown that interventions, such as anemia correction or treatment of hypertension and/or chronic heart failure (CHF), can result in moderate regression of LVH. The primary objective of our study was to investigate the effects of a multi-interventional treatment strategy on LVH in HD patients. 〈 i 〉 Methods and Results: 〈 /i 〉 In a series of 202 consecutive HD patients, we combined optimized CHF therapy, including β-blockers (BB), ACE inhibitors and angiotensin receptor blockers (ARBs), to target doses with full anemia correction by epoetin β (hemoglobin (Hb) target males 14.5 g/dl, females 13.5 g/dl). Serial echocardiograms were recorded every 3–6 months. Mean follow-up was 3.4 ± 1.2 years. Mean Hb at baseline was 11.4 ± 1.4 vs. 14.6 ± 1.6 g/dl (p 〈 0.001) at study end. There was a significant reduction in left ventricular mass index (LVMI, 159 ± 65 vs. 132 ± 46 g/m 〈 sup 〉 2 〈 /sup 〉 (p 〈 0.001)), an improvement in left ventricular ejection fraction (LVEF, 60 ± 15 vs. 66 ± 12% (p 〈 0.01)) and in NYHA class (2.8 ± 0.76 vs. 1.96 ± 0.76 (p 〈 0.01)) from baseline to follow-up in the overall study population. In a subgroup of 70 patients, LVMI returned to normal (169 ± 33 vs. 114 ± 14 g/m 〈 sup 〉 2 〈 /sup 〉 (p 〈 0.001)) after 1.4 ± 1 years. 〈 i 〉 Conclusions: 〈 /i 〉 Our study shows that optimized CHF therapy, in combination with anemia correction to normal Hb targets, results in a significant reduction of LVH, an increase in LVEF and an improvement in NYHA class. Moreover, in contrast to previous studies, our data also demonstrate that complete regression and prevention of LVH in HD patients is possible.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000085881
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2005
    detail.hit.zdb_id: 1468523-1
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