Department of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
J Cardiol. 2013 Oct;62(4):249-56. doi: 10.1016/j.jjcc.2013.04.008. Epub 2013 Jun 18.
To assess effects of long-term anemia management on left ventricular hypertrophy in patients with chronic kidney disease (CKD) not on dialysis, we performed secondary outcome analyses of a randomized controlled study that evaluated effects of anemia management with erythropoiesis stimulating agents in this population.
Subjects [hemoglobin (Hb)<10.0 g/dL, 2.0 ≤ serum creatinine<6.0mg/dL] were randomized either to high Hb (11.0 ≤ target Hb ≤ 13.0 g/dL with darbepoetin alfa), or to low Hb group (9.0 ≤ target Hb ≤ 11.0 g/dL with recombinant human erythropoietin), and followed up to 48 weeks. Data from echocardiographic evaluation and values of neurohumoral factors associated with heart failure were assessed in subjects whose data were evaluable both at the baseline and at the end point.
The high Hb group achieved target range Hb levels (12.1 ± 1.1g/dL, at 32 weeks, N=111), which was significantly higher (p<0.001) than the low Hb group (N=95). Though blood pressure and renal function changes were similar between the groups, left ventricular diastolic dimension was significantly decreased only in the high Hb group (p < 0.001), and the change in left ventricular mass index (LVMI) correlated coarsely but significantly with the achieved Hb levels (r = 0.147, p = 0.032). The higher Hb levels were associated with greater reduction in LVMI and left ventricular wall thickness, and the lower Hb levels with the greater increase in human arterial- or brain natriuretic polypeptide levels.
Anemia correction targeting modestly higher Hb levels better preserves cardiac function in CKD patients not on dialysis.
为评估非透析慢性肾脏病（CKD）患者长期贫血管理对左心室肥厚的影响，我们对一项评价红细胞生成刺激剂治疗该人群贫血的随机对照研究进行了次要终点分析。
受试者（血红蛋白[Hb]<10.0 g/dL，2.0 ≤血清肌酐<6.0mg/dL）随机分为高 Hb 组（目标 Hb 为 11.0 ≤ 13.0 g/dL，用达贝泊汀 alfa 治疗）或低 Hb 组（目标 Hb 为 9.0 ≤ 11.0 g/dL，用重组人红细胞生成素治疗），随访 48 周。对基线和终点时均可评估数据的受试者进行超声心动图评估和与心力衰竭相关的神经激素因子值评估。
高 Hb 组达到目标 Hb 范围（12.1 ± 1.1g/dL，在 32 周时，N=111），明显高于低 Hb 组（N=95）（p<0.001）。尽管两组间血压和肾功能变化相似，但仅高 Hb 组左心室舒张末期内径明显降低（p < 0.001），左心室质量指数（LVMI）的变化与达到的 Hb 水平呈粗糙但显著相关（r = 0.147，p = 0.032）。较高的 Hb 水平与 LVMI 和左心室壁厚度的更大降低相关，较低的 Hb 水平与脑钠肽或人动脉钠肽水平的更大升高相关。
针对适度较高 Hb 水平的贫血纠正可更好地保护非透析 CKD 患者的心脏功能。
