Effects of Early and Late Intervention with Epoetin α on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4): Results of a Randomized Clinical Trial

It is not known whether prevention of anemia among patients with chronic kidney disease would affect the development of progression of left ventricular (LV) hypertrophy. A randomized controlled trial was performed with 155 patients with chronic kidney disease (creatinine clearance. 15 to 50 ml/min), with entry hemoglobin concentrations ([Hb]) of 110 to 120 g/L (female patients) of 110 to 130 g/L (male patients). Patients were monitored for 2 yr or until they required dialysis: the patients were randomized to receive epoetin α as necessary to maintain [Hb] between 120 and 130 g/L (group A) or between 90 and 100 g/L (group B). [Hb] increased for group A (from 112 ± 9 to 121 ± 14 g/L, mean ± SD) and decreased for group B (from 112 ± 8 to 108 ± 13 g/L) (P < 0.001, group A versus group B). On an intent-to-treat analysis, the changes in LV mass index for the groups during the 2-yr period were not significantly different (2.5 ± 20 g/m ² for group A versus 4.5 ± 20 g/m² for group B, P = NS). There was no significant difference between the groups in 2-yr mean unadjusted systolic BP (141 ± 14 versus 138 ± 13 mmHg) or diastolic BP (80 ± 6 versus 79 ± 7 mmHg). The decline in renal function in 2 yr, as assessed with nuclear estimations of GFR, also did not differ significantly between the groups (8 ± 9 versus 6 ± 8 ml/ min per 1.73 m²). In conclusion, maintenance of [Hb] above 120 g/L, compared with 90 to 100 g/L, had similar effects on the LV mass, index and did not clearly affect the development or progression of LV hypertrophy. The maintenance of [Hb] above 100 g/L for many patients in group B might have been attributable to the relative preservation of renal function.