Suzuki Makoto, Hada Yoshiyuki, Akaishi Makoto, Hiroe Michiaki, Aonuma Kazutaka, Tsubakihara Yoshiharu, Akizawa Tadao
Department of Clinical Laboratory, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan.
Int Heart J. 2012;53(4):238-43. doi: 10.1536/ihj.53.238.
Anemia is a significant risk factor for patients with chronic kidney disease (CKD). Here, we investigated the effects of anemia correction on cardiac functions in CKD patients. Pre-dialysis CKD patients (n = 171) without known risk factors for cardiovascular disease (CVD) other than CKD with hemoglobin (Hb) concentrations < 10.0 g/dL were enrolled for evaluation of cardiac functions and biomarkers before and after the 16-week treatment of erythropoiesis-stimulating agents. The treatment significantly increased Hb concentrations in all patients who completed the study (n = 143, 8.91 ± 0.87 versus 11.27 ± 1.31 g/dL; n < 0.001) and among patients whose echocardiograms were available for evaluation (n = 77, 8.92 ± 0.94 versus 11.24 ± 1.13 g/dL; P < 0.001). The left ventricular mass index (LVMI) was decreased (121.3 ± 25.8 versus 114.7 ± 25.1 g/m(2), n = 77, P = 0.012) and significant correlation between the change in the LVMI and Hb concentration was noted (P = 0.011). The levels of B-type natriuretic peptide and human atrial natriuretic peptide, and the cardio-thoracic ratio were significantly increased among subjects with Hb concentrations < 11.0 g/dL at completion of the study. The changes in these parameters were significantly correlated with the Hb concentrations (P = 0.033, P = 0.011, and P < 0.001, respectively). No significant differences were observed in the electrocardiographic parameters. Correcting Hb levels higher than those conventionally recommended reduced left ventricular hypertrophy and myocardial stress, lowering risks for CVD in pre-dialysis CKD patients.
贫血是慢性肾脏病（CKD）患者的一个重要风险因素。在此，我们研究了纠正贫血对CKD患者心脏功能的影响。入选了171例无除CKD外已知心血管疾病（CVD）风险因素、血红蛋白（Hb）浓度<10.0 g/dL的透析前CKD患者，在接受促红细胞生成素治疗16周前后评估其心脏功能和生物标志物。治疗使所有完成研究的患者（n = 143，8.91±0.87对11.27±1.31 g/dL；P<0.001）以及超声心动图可用于评估的患者（n = 77，8.92±0.94对11.24±1.13 g/dL；P<0.001）的Hb浓度显著升高。左心室质量指数（LVMI）降低（121.3±25.8对114.7±25.1 g/m²，n = 77，P = 0.012），且LVMI变化与Hb浓度之间存在显著相关性（P = 0.011）。在研究结束时，Hb浓度<11.0 g/dL的受试者中，B型利钠肽和人心房利钠肽水平以及心胸比显著升高。这些参数的变化与Hb浓度显著相关（分别为P = 0.033、P = 0.011和P<0.001）。心电图参数未观察到显著差异。将Hb水平纠正至高于传统推荐水平可减轻左心室肥厚和心肌应激，降低透析前CKD患者发生CVD的风险。
