| Erythropoiesis-stimulating agents, hypertension and left ventricular hypertrophy in the chronic kidney disease patient. | |
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MedLine Citation:
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PMID: 21738032 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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PURPOSE OF REVIEW: Left-ventricular hypertrophy (LVH) represents an important marker of cardiovascular morbidity and mortality. Numerous noninterventional studies in patients with chronic kidney disease (CKD) revealed a consistent relationship of LVH with modifiable risk factors attributable to failing renal function, particularly anemia and hypertension. RECENT FINDINGS: Given the clear role for anemia in initiating or accelerating LVH, it seems imperative to correct renal anemia with erythropoiesis-stimulating agents (ESAs). A few nonrandomized studies have described a regression of LVH with correction of anemia, but prospective randomized trials showed no evidence that ESA treatment is able to improve cardiac prognosis in the CKD patient. Current data alert physicians that normalization of hemoglobin in patients with advanced CKD is harmful. Recent studies are now trying to clarify the mechanisms for harm focussing on the influence of comorbidities, ESA doses, and hemoglobin variability. The pathogenesis of hypertension in CKD is multifactorial and only a small percentage of CKD patients have controlled their blood pressure, indicating poor medication adherence, insufficient control of volume overload and undertreatment. SUMMARY: This review provides an update of ESA treatment, hypertension and LVH in the CKD patient, indicating that pathogenesis of LVH in this population is currently not completely understood. In addition, the impact of pharmacological interventions targeted to prevent or reduce LVH in anemic or hypertensive CKD patients is not well defined. As adoption of the Framingham approach seems not feasible in the CKD patient, evidence from large-scale randomized clinical trials is mandatory to resolve this dilemma. |
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Authors:
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Holger Schmid; Helmut Schiffl; Stephan R Lederer |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-7-6 |
Journal Detail:
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Title: Current opinion in nephrology and hypertension Volume: - ISSN: 1535-3842 ISO Abbreviation: - Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-7-8 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9303753 Medline TA: Curr Opin Nephrol Hypertens Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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aKfH Nierenzentrum Muenchen - Laim bDepartment of Internal Medicine, University Hospital Munich, University of Munich, Munich, Germany. |
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