Cardiac functions in anemic patients due to chronic renal disease

Abstract

Patients on chronic hemodialysis (HD) have traditional and renal-disease-associated cardiac risk factors and consequently high cardiac morbidity and mortality. As in the general population, mortality correlates with the presence, extent and progression of left ventricular hypertrophy (LVH), which has emerged as an independent predictor of clinical outcome. Anemia is a common feature of CKD and its prevalence has been increasing with diminishing renal function, leading to a large proportion of patients who enter for dialysis in an anemic state. The major pathogenetic factor of renal anemia is inadequate production of erythropoietin from the diseased kidneys, abbreviated life of erythrocytes, the deficit of nutritional factors and disturbance of iron metabolism causing an inappropriately low level of red cell production. This study aimed to evaluate the effect of correction of anemia with erythropoietin on cardiac structure & function in hemodialysis patients. The present study included 60 subjects who were divided into 3 groups: Group I included 20 CKD patients on regular hemodialysis with Hb <10.5 gm% were not receiving erythropoietin, Group II included 20 CKD patients on regular hemodialysis with Hb ≥ 10.5 gm% receiving erythropoietin and Group III included 20 CKD patients with renal insufficiency were not on regular hemodialysis and were not receiving erythropoietin. In the present study hypertension was the most common cause of CKD in all groups followed by GN then other causes. In the present study disease duration was positively correlated with Hb, Hct and with EF but it was negatively correlated with SGA score. As regard SGA score our study found that most of the patients of Group II (were on regular hemodialysis, with Hb ≥ 10.5 gm% receiving erythropoietin) had the best score as represented by grade A (well nourished) while patients of Group I (were on regular hemodialysis with Hb <10.5 gm% not receiving erythropoietin) had the lowest score as represented by grade C. In the present study, we found that group I patients who didn't receive erythropoietin were more anemic than group II patients who receive erythropoietin so Hb and Hct levels were lower among group I compared with group II. In the present study, we found that hemoglobin level and Hct were negatively correlated with LVMI& LVESV, LVEDV, LV mass. In the present study, cumulative erythropoietin dose was positively correlated with Hb level, Hct and EF while it was negatively correlated with LVESV, LVEDV and LVM.