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The major aims of dialysis therapy consist in pro- in prospective randomized multicentre studies. There- longing patients' survival, reducing the patients mor- fore the question arises as to what extent anaemia bidity and improving their quality of life. However should be corrected in order to avoid undesirable despite many technical advances in the medical care side-eVects. and in the delivery of dialysis over the past years, mortality and morbidity of dialysis patients remains persistently high and their quality of life is rather poor. The Japanese data A Japanese retrospective study (6 ), analysing a total Anaemia as cardiovascular risk factor of 2116 patients has reported that the administration of rHuEpo might be responsible for an increased risk Hypertension and anaemia play a pivotal role in the of cardiovascular disease (especially stroke and acute increased mortality and morbidity in uremic patients myocardial infarction), although only a trend towards and should be managed appropriately. In fact anaemia an increase in the incidence of stroke and acute has been found to be an independent risk factor for myocardial infarction was noted. However, some relev- developing cardiac morbidity and mortality in dialysis ant methodological drawbacks were underlined (7,8). patients (1,2) and cardiovascular disease is the major This study prompted us to further clarify this important cause of death in these patients. It is well known that aspect. We performed a historical prospective study cardiac hypertrophy is very frequent in dialysis patients concerning the clinical eVects of the use of rHuEpo in and anaemia and hypertension are very important risk patients dialysed in Lombardy. The study aimed at factors in this complication, clearly related to the clarifying the clinical impact of anaemia and rHuEpo cardiovascular mortality, as anaemia is accompanied treatment on general and cardiovascular mortality and by an increase of cardiac work that induces left morbidity. ventricular hypertrophy. Of course other factors are important in inducing left ventricular hypertrophy, as arteriovenous fistula and, among other hormones, The Lombardy data parathyroid hormone (3).

nephrology, dialysis, transplantation/nephrology dialysis transplantation

The impact of haematocrit levels and erythropoietin treatment on overall and cardiovascular mortality and morbidity - the experience of the Lombardy Dialysis Registry