Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD Patients: A Meta-Analysis

Background and objectives: The purpose was to evaluate changes in the left ventricular mass index (LVMi) among anemic chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients treated with recombinant human erythropoietin (EPO). Design, setting, participants, & measurements: A systematic review of the literature, reporting LVMi for patients before and after EPO therapy, was performed. The change in LVMi from baseline to the end of treatment was calculated and stratified by severity of anemia at baseline, target hemoglobin (Hb), and stage of kidney disease. Results: Fifteen eligible studies involving 1731 patients were identified. Cohorts with severe anemia at baseline (<10 g/dl), when given EPO using a lower target level (Hb <= 12 g/dl or Hct <= 36%) experienced significant reductions in LVMi (-32.7 g/m(2); 95% CI: -49.4 to -16.1, P < 0.05). However, these studies lacked control groups. Cohorts with moderate anemia at baseline showed insignificant changes in LVMi: 5.3 g/m(2) (95% CI: -0.8 to 11.3) for patients assigned to a lower target, and -6.6 g/m(2) (95% CI: -17.2 to 4.0) for patients assigned to a higher target (Hb > 12 g/dl or Hct > 36%). The effect size was similar in direction for both CKD and ESRD cohorts. Conclusions: Aggregated results from multiple studies suggest that in severe anemia conventional Hb targets for LPO therapy are associated with a reduction in LVMi, but that in moderate anemia target Hb above 12 g/dl does not have a significant beneficial impact on LVMi compared with conventional targets.