In chronic kidney disease patients, different levels of anemia treatment have a beneficial effect on the heart and improve quality of life, according to a pair of studies appearing in the April 2009 issue of the Clinical Journal of the American Society Nephrology (CJASN).
The findings indicate that different levels of treatment may be warranted for different patients.
Patients with chronic kidney disease often have low levels of erythropoietin (a hormone that stimulates the formation of red blood cells) and develop anemia. Anemia can cause enlargement of the heart, predisposing individuals to heart failure and death. Synthetic erythropoietin partially corrects anemia, and doctors prescribe it to try to increase patients' hemoglobin levels to 10-12 g/dl (hemoglobin is the predominant protein in red blood cells). Prescribing higher levels of erythropoietin may result in normal hemoglobin levels (greater than 13 g/dl), but recent clinical trials suggest that this may cause serious adverse effects, including death.
Two recent studies by Patrick Parfrey, MD (Memorial University of Newfoundland), and colleagues examined the effects of different levels of anemia treatment on heart structure and quality of life in chronic kidney disease patients.
The first study was a systematic review of published data on the effects of anemia on the heart. By analyzing 15 available studies involving 1,731 patients with kidney disease, the investigators found that partial correction of severe anemia with erythropoietin improved heart structure, but fully correcting anemia provided no additional benefit.