Ayus Juan Carlos, Go Alan S, Valderrabano Fernando, Verde Eduardo, de Vinuesa Soledad Garcia, Achinger Steven G, Lorenzo Victor, Arieff Allen I, Luño Jose
The University of Texas Health Science Center at San Antonio, San Antonio, Texas 782293, USA.
Kidney Int. 2005 Aug;68(2):788-95. doi: 10.1111/j.1523-1755.2005.00458.x.
Left ventricular hypertrophy (LVH) frequently complicates chronic renal insufficiency. Anemia is also common in these patients and may contribute to LVH.
We conducted an open-label interventional trial to evaluate the effect of recombinant erythropoietin (rhEPO) on left ventricular mass index (LVMI) in anemic patients with renal insufficiency. Adults with creatinine clearance 10 to 30 mL/min (nondiabetics) or 20 to 40 mL/min (diabetics) were recruited, and rhEPO was given to those with anemia (hemoglobin level <10 g/dL). Baseline and 6-month LVMI and LVH (LVMI >130 g/m(2) in men and >100 g/m(2) in women), hemoglobin levels, creatinine clearance, blood pressure, medications, and medical history were obtained. Forty anemic and 61 nonanemic control subjects were enrolled.
Overall, the prevalence of LVH was 68.3% (95% CI 58.3-77.2), and entry hemoglobin level was the only significant predictor of baseline LVH (adjusted OR 0.69 per g/dL increase in hemoglobin, 95% CI 0.50-0.94). After 6 months, LVMI decreased in anemic patients receiving rhEPO (142 +/- 56 vs. 157 +/- 56 g/m(2)) (P= 0.007), with an increase in hemoglobin (11.3 +/- 1.9 vs. 9.1 +/- 0.7 g/dL) (P= 0.001). There were no changes in LVMI or hemoglobin level among controls. After adjusting for confounders and change in hemoglobin, receipt of rhEPO was associated with a significant reduction in LVMI (P= 0.01).
Treatment with rhEPO was not independently associated with significant changes in blood pressure or renal function. LVH is a common finding in chronic renal insufficiency and is associated with lower hemoglobin levels. Treatment with rhEPO may decrease LVH in patients with severe renal insufficiency and anemia.
左心室肥厚（LVH）常使慢性肾功能不全复杂化。贫血在这些患者中也很常见，可能促成LVH。
我们进行了一项开放标签干预试验，以评估重组促红细胞生成素（rhEPO）对肾功能不全贫血患者左心室质量指数（LVMI）的影响。招募了肌酐清除率为10至30 mL/分钟（非糖尿病患者）或20至40 mL/分钟（糖尿病患者）的成年人，给贫血患者（血红蛋白水平<10 g/dL）使用rhEPO。获取基线和6个月时的LVMI和LVH（男性LVMI>130 g/m²，女性>100 g/m²）、血红蛋白水平、肌酐清除率、血压、用药情况和病史。共纳入40例贫血患者和61例非贫血对照受试者。
总体而言，LVH的患病率为68.3%（95%可信区间58.3 - 77.2），入组时的血红蛋白水平是基线LVH的唯一显著预测因素（血红蛋白每增加1 g/dL，校正比值比为0.69，95%可信区间0.50 - 0.94）。6个月后，接受rhEPO的贫血患者LVMI下降（142±56 vs. 157±56 g/m²）（P = 0.007），血红蛋白升高（11.3±1.9 vs. 9.1±0.7 g/dL）（P = 0.001）。对照组的LVMI和血红蛋白水平无变化。在调整混杂因素和血红蛋白变化后，接受rhEPO与LVMI显著降低相关（P = 0.01）。
rhEPO治疗与血压或肾功能的显著变化无独立相关性。LVH在慢性肾功能不全中很常见，且与较低的血红蛋白水平相关。rhEPO治疗可能会降低严重肾功能不全和贫血患者的LVH。
