Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy

Robert N. Foley, Patrick S. Parfrey, Janet Morgan, Paul E. Barre, Pierre Campbell, P. Cartier, Douglas Coyle, Adrian Fine, Paul Handa, Iris Kingman, Cathy Y. Lau, Adeera Levin, David Mendelssohn, Norman Muirhead, Brendan Murphy, Richard K. Plante, Gerald Posen, George A. Wells

Research output: Contribution to journalArticlepeer-review

352 Scopus citations


Background. Hemoglobin levels below 10 g/dL lead to left ventricular (LV) hypertrophy, LV dilation, a lower quality of life, higher cardiac morbidity, and a higher mortality rate in end-stage renal disease. The benefits and risks of normalizing hemoglobin levels in hemodialysis patients without symptomatic cardiac disease are unknown. Methods. One hundred forty-six hemodialysis patients with either concentric LV hypertrophy or LV dilation were randomly assigned to receive doses of epoetin β designed to achieve hemoglobin levels of 10 or 13.5 g/dL. The study duration was 48 weeks. The primary outcomes were the change in LV mass index in those with concentric LV hypertrophy and the change in cavity volume index in those with LV dilation. Results. In patients with concentric LV hypertrophy, the changes in LV mass index were similar in the normal and low target hemoglobin groups. The changes in cavity volume index were similar in both targets in the LV dilation group. Treatment-received analysis of the concentric LV hypertrophy group showed no correlation between the change in mass index and a correlation between the change in LV volume index and mean hemoglobin level achieved (8 mL/m2 per 1 g/dL hemoglobin decrement, P = 0.009). Mean hemoglobin levels and the changes in LV mass and cavity volume index were not correlated in patients with LV dilation. Normalization of hemoglobin led to improvements in fatigue (P = 0.009), depression (P = 0.02), and relationships (P = 0.004). Conclusions. Normalization of hemoglobin does not lead to regression of established concentric LV hypertrophy or LV dilation. It may, however, prevent the development of LVdilation, and it leads to improved quality of life.

Original languageEnglish (US)
Pages (from-to)1325-1335
Number of pages11
JournalKidney international
Issue number3
StatePublished - Sep 2000


  • Chronic hemodynamic stress
  • End-stage renal disease
  • Epoetin α
  • Ischemic heart disease
  • Progressive renal disease
  • Ventricular enlargement

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