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Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents

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Abstract

Background

Recent experimental studies suggest that erythropoietin promotes beneficial myocardial remodeling during left ventricular hypertrophy (LVH); however, such compensatory capacity may be limited due to insufficient erythropoietin production in chronic kidney disease patients. Thus, this study aimed to explore the effect of pre-dialysis erythropoiesis-stimulating agent (ESA) use on the prognostic significance of LVH in dialyzed patients.

Methods

This retrospective study included 404 consecutive patients who started dialysis between 2001 and 2009. The interaction of ESA with the association between left ventricular mass index (LVMI) observed at dialysis initiation and all-cause and cardiovascular mortality was analyzed at the end of 2010 using the Cox model.

Results

During a median follow-up of 36.5 months, 164 patients died, 31 of them from heart failure. The frequency of pre-dialysis ESA use was 58.7 % and median LVMI was 160.3 g/m2. Of interest, patients with the lowest tertile of LVMI had worse survival compared with those with each subsequent tertile. LVMI was inversely associated with all-cause mortality [hazard ratio (HR) 0.991, 95 % confidence interval (CI) 0.988–0.995, P = 0.000] after extensive adjustment including ejection fraction, whereas the prognostic value of LVMI for cardiovascular mortality was dependent on pre-dialysis ESA use [adjusted HR 1.010, 95 % CI 0.999–1.020, P = 0.065 for pre-dialysis ESA(+) and 0.978, 95 % CI 0.967–0.989, P = 0.000 for pre-dialysis ESA(−), respectively].

Conclusions

Our results suggest that reverse epidemiology may exist between LVH and mortality and that pre-dialysis ESA use may modify the prognostic significance of LVH observed at dialysis initiation for cardiovascular mortality in dialyzed patients.

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Acknowledgments

We thank all the physicians and staff at the 34 community-based hemodialysis sites, especially Dr. Harumi Nagayama, Shuji Okazaki (Nagayama hospital), Hiromi Nogami, Motoki Ohno (Nogami Hospital), Takahiro Nishide, Keiji Mimura (Nishide Hospital), Issei Uematsu (Habara Hospital), Takehiro Tamai (Tamai Internal Medicine and Orthopedics Hospital), Yasushi Saika (Fujii Clinic) and Kinya Hanada (Daini-Nagisa Clinic).

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Author notes

  1. Keiko Yasuda

    Present address: Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan

  2. Koichi Sasaki

    Present address: Department of Nephrology, Osaka Koseinenkin Hospital, Osaka, Japan

  3. Yoshiharu Tsubakihara

    Present address: Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Suita, Japan

Authors and Affiliations

  1. Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan

    Terumasa Hayashi & Yoshiharu Tsubakihara

  2. Department of Nephrology, Rinku General Medical Center, Izumisano, Japan

    Terumasa Hayashi, Keiko Yasuda & Koichi Sasaki

  3. Matsuyama Red-Cross Hospital, Matsuyama, Japan

    Taro Kamimura

  4. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan

    Tomonori Kimura, Yoshitsugu Obi, Harumi Kitamura, Hiromi Rakugi & Yoshitaka Isaka

  5. Department of Nephrology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Japan

    Kenichiro Iio & Kenro Miyasato

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  1. Terumasa Hayashi
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  2. Tomonori Kimura
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Correspondence to Terumasa Hayashi.

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Hayashi, T., Kimura, T., Yasuda, K. et al. Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents. Clin Exp Nephrol 17, 294–303 (2013). https://doi.org/10.1007/s10157-012-0705-4

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  • DOI: https://doi.org/10.1007/s10157-012-0705-4

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