Anemia and left ventricular hypertrophy in chronic kidney disease populations: a review of the current state of knowledge

Abstract

The increasing awareness of the high prevalence of cardiovascular disease (CVD) in the dialysis population has led clinical nephrologists and researchers to focus their attention on processes and factors that are present in patients prior to dialysis. It is clear that many of the risk factors for kidney disease and cardiovascular disease are similar: This may account for the high prevalence of CVD within the dialysis population. However, it is evident that there are unique risk factors for CVD that are present in patients with chronic kidney disease (CKD). These unique uremia-related risk factors for CVD include anemia, hyperparathyroidism, abnormalities of mineral metabolism, and acidosis. Of note, the association of anemia, or lower levels of hemoglobin, have been consistently described in all populations with kidney disease. Left ventricular hypertrophy has long been known as an independent risk factor for death and CV events, in both the dialysis and general populations. There have been accumulating data that LVH and left ventricular (LV) growth occur prior to dialysis in patients with kidney disease, and that the prevalence of LVH in that group of patients is caused by, conventional risk factors for LVH (e.g., hypertension) as well as nonconventional risk factors such as anemia.