To determine the possible association between anemia and clinical and echocardiographic cardiac disease, a cohort of 432 end-stage renal disease patients (261 on hemodialysis and 171 on peritoneal dialysis) who started dialysis therapy between 1982 and 1991 were followed prospectively for an average of 41 months. Baseline demographic, clinical, and echocardiographic assessments were performed, as well as monthly serial clinical and laboratory tests while the patients were on dialysis therapy. The mean (±SD) hemoglobin level during dialysis therapy was 8.8 ± 1.5 g/dL. After adjusting for age, diabetes, and ischemic heart disease, as well as for blood pressure and serum albumin levels measured serially, each 1 g/dL decrease in mean hemoglobin was independently associated with the presence of left ventricular dilatation on repeat echocardiogram (odds ratio, 1.46; P = 0.018) end the development of de hove (relative risk [RR] = 1.28; P = 0.018) end recurrent (RR = 1.20; P = 0.046) cardiac failure. In addition, each 1 g/dL decrease in the mean hemoglobin level was independently associated with mortality while the patients were on dialysis therapy (RR = 1.14; P = 0.024). Anemia had no independent association with the development of ischemic heart disease while the patients were on dialysis therapy. Anemia, an easily reversible feature of end-stage renal disease, is an independent risk factor for clinical and echocardiographic cardiac disease, as well as mortality in end-stage renal disease patients.
Bibliographical noteFunding Information:
Of 518 patients who survived at least 6 months from the From the Division of Nepkrology, The Health Sciences Centre, Memorial University, St John’s, Newfoundland; the Division of Nepkrology, Salvation Army Grace General Hospital, St John’s, Newfoundland; and the Division of Nepkrol-ogy, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. Received June 15, 1995; accepted in revised form February 20, 1996. Dr Foley was the 1992-1994 Baxter/Canadian Society of Nepkrology/Kidney Foundation of Canada Research Fellow. This research wasfunded in its initial phase by the Canadian Heart Foundation and subsequently by the Kidney Foundation of Canada and by Amgen Corporation, Thousand Oaks, CA. Address reprint requests Robert N. Foley, MB, Memorial University of Newfoundland, The Health Sciences Centre, St John’s, Newfoundland, Canada AIB 3V6. 0 1996 by the National Kidrzey Foundation, 0272.6386/96/2801-0007$3.00/O
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- end-stage renal disease