Anemia and heart failure in chronic kidney disease

Cardiovascular disease is mainly responsible for the poor long-term survival observed in chronic kidney disease (CKD) patients on dialytic treatment. Anemia is an early complication of CKD and, by inducing important cardiovascular alterations, first of all left ventricular hypertrophy, it does not only impair quality of life, but has also been shown to be an independent risk factor for adverse cardiovascular outcomes in CKD patients. Clinical studies, although with discordant results, have shown that cardiovascular benefits, mainly in terms of left ventricular hypertrophy regression, may be achieved by a partial correction of hemoglobin levels, however, it still is unclear whether starting anemia correction in a very early phase of CKD or aiming for complete normalization of hemoglobin levels higher than the targets recommended by current guidelines may provide further cardiovascular advantages. Results of ongoing, large-scale, prospective, randomized, clinical trials therefore are awaited with much interest to clarify better which practices of anemia correction may provide the best results on the improvement of cardiovascular status and thus of long-term survival of patients with renal disease.