The beneficial effects of intervention in early renal disease.

In renal disease, anaemia is a risk factor for cardiovascular disease (CVD), such as left ventricular hypertrophy (LVH), in both dialysis patients and patients with early renal disease. During the past decade, many studies have showed that partial correction of anaemia leads to partial regression of LVH in hypertensive and normotensive dialysis patients. Several reports support the pre-dialysis use of epoetin. Evidence of cardiovascular risk reduction with epoetin treatment in pre-dialysis patients is growing. For example, in an open, prospective study of epoetin in pre-dialysis patients, an increase in mean haemoglobin of 2.7 g/dl was accompanied by a decrease in left ventricular mass index in almost all patients. This regression, obtained in the absence of improved blood pressure (BP) control, confirms the role of anaemia in the genesis of LVH. These results have been confirmed in two recent studies. Risk reduction strategies (i.e. BP control, lipid lowering, smoking cessation, anaemia correction) from the earliest stages of renal disease may facilitate the prevention of cardiovascular conditions such as LVH in chronic renal failure (CRF) patients. Indeed, if all the well recognized risk factors (including anaemia) are aggressively identified and treated, then long-term reductions in cardiovascular morbidity and mortality should be achieved. In conclusion, preliminary studies show reversal of hypertrophy after correction of renal anaemia with epoetin. Extrapolation of results from studies in CRF suggests the use of earlier treatment of anaemia to maximize cardiovascular benefits. Further studies of the cardiovascular benefits of earlier epoetin intervention in early renal disease are indicated.