Background: LVH is the most important risk factor for cardiovascular disease in hemodialysis (HD) patients (pts).Anemia in chronic renal disease (CRD), by complex mechanism, leads to hemodinamic changes and ventricular dilatation and hypertrophy.Adaptive changes, that affects LV in CRD, implicates also ACE participation in ventricular remodeling. Objective: To analize potential association of serum ACE activity and LVH in HD pts with anemia treated with human recombinant erythropoietin /rHuEpo/ during six monts. Method: Two-dimensional and M-mode echocardiography determined LV geometry.Serum ACE activity was measured by spectrophotometric method using hippyril-histidil-l-leucin as a substrat.Renal anemia was treated by rHuEpo according to recommending doses. Results: The rHuEpo treatment of anemia in HD pts led to significant increase of red blood cells and hemoglobin.In the some time, LV mass index of treated pts with LVH was significantly reduced (p=0,008), while LV volumen was decreased for 17,95% (p=0,07).Our investigation showed that serum ACE activity increased to 47,3% in HD pts with LVH as compared to pts with LV normal mass.Also, the significant positive correlation was found between the level of ACE activity and LV mass index (p=0,004).Six months treatment of anemia with rHuEpo in HD pts with LVH caused significantly reduction of serum ACE activity (p=0,003) as compared with the initial values of ACE activity, as well as reduction of LV mass index. Conclusion: Correction of anemia with rHuEpo leads to significant partial regresion of LVH.Levels of serum ACE activity are associated with LV geometry.Our findings suggest a possibility of the simultaneously and modestly modulation of LV mass and serum ACE activity with rHuEpo correction of renal anemia.