Double-Blind Comparison of Full and Partial Anemia Correction in Incident Hemodialysis Patients without Symptomatic Heart Disease
Patrick S. Parfrey,Robert N. Foley,Barbara H. Wittreich,Daniel J. Sullivan,Martin J. Zagari,Dieter Frei +5 more
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TLDR
Overall adverse event rates were similar in both target groups; higher rates of skeletal pain, surgery, and dizziness were seen in the lower target group, and headache and cerebrovascular events wereseen in the higher target group.Abstract:
It is unclear whether physiologic hemoglobin targets lead to cardiac benefit in incident hemodialysis patients without symptomatic heart disease and left ventricular dilation. In this randomized, double-blind study, lower (9.5 to 11.5 g/dl) and higher (13.5 to 14.5 g/dl) hemoglobin targets were generated with epoetin α over 24 wk and maintained for an additional 72 wk. Major eligibility criteria included recent hemodialysis initiation and absence of symptomatic cardiac disease and left ventricular dilation. The primary outcome measure was left ventricular volume index (LVVI). The study enrolled 596 patients. Mean age, duration of dialysis therapy, baseline predialysis hemoglobin, and LVVI were 50.8 yr, 0.8 yr, 11.0 g/dl, and 69 ml/m 2 , respectively; 18% had diabetic nephropathy. Mean hemoglobin levels in the higher and lower target groups were 13.3 and 10.9 g/dl, respectively, at 24 wk. Percentage changes in LVVI between baseline and last value were similar (7.6% in the higher and 8.3% in the lower target group) as were the changes in left ventricular mass index (16.8 versus 14.2%). For the secondary outcomes, the only between-group difference was an improved SF-36 Vitality score in the higher versus the lower target group (1.21 versus −2.31; P = 0.036). Overall adverse event rates were similar in both target groups; higher ( Pread more
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Pre-End-Stage Renal Disease Hemoglobin Variability Predicts Post-End-Stage Renal Disease Mortality in Patients Transitioning to Dialysis.
Keiichi Sumida,Charles Dyer Diskin,Miklos Z. Molnar,Miklos Z. Molnar,Praveen K. Potukuchi,Fridtjof Thomas,Jun Ling Lu,Connie M. Rhee,Elani Streja,Kunihiro Yamagata,Kamyar Kalantar-Zadeh,Csaba P. Kovesdy,Csaba P. Kovesdy +12 more
TL;DR: High pre-ESRD Hb-var is associated with higher mortality, particularly from infectious causes rather than cardiovascular causes, and further research is required to clarify the underlying mechanisms and true causal nature of the observed association.
Erythropoiesis-stimulating agents for anemia of chronic kidney disease: systematic review and economic evaluation
TL;DR: Outcomes were all-cause or cardiovascular mortality; myocardial infarction, stroke, heart failure or revascularisation; hospitalisation, vascular access loss, or dialysis dependence; glomerular filtration rate; quality of life assessed by the Kidney Disease Questionnaire (KDQ) fatigue section or the Short Form health survey.
Journal ArticleDOI
Effects of high-volume online mixed-hemodiafiltration on anemia management in dialysis patients.
L. Pedrini,Adam M Zawada,Anke Winter,Jenny Pham,Gudrun Klein,Melanie Wolf,Astrid Feuersenger,Pio Ruggiero,Annalisa Feliciani,Carlo Barbieri,Adelheid Gauly,Bernard Canaud,Stefano Stuard +12 more
TL;DR: Results of the explorative study suggest that patients on Mixed-HDF may have clinical benefits in terms of anemia management and may also have a beneficial economic impact.
Journal ArticleDOI
The normal hematocrit cardiac trial revisited.
TL;DR: The Normal Hematocrit Cardiac Trial (NHCT) was the first large, randomized study of patients receiving hemodialysis to examine the outcomes of treating anemia to a target hematocrit range versus maintaining partial correction, and findings from more recent studies in the field are highlighted.
Journal ArticleDOI
The epidemics of cardiovascular disease in elderly patients with chronic kidney disease--two facets of the same problem
TL;DR: This review deals briefly with the most significant data published in the last decade on CVD in elderly with CKD, and elderly renal patients receive less proper cardiovascular therapy compared to non-renal subjects of the same age.
References
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Anatole Besarab,W K Bolton,J K Browne,Joan C. Egrie,Allen R. Nissenson,D M Okamoto,Steve J. Schwab,David A. Goodkin +7 more
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Robert N. Foley,Patrick S. Parfrey,Patrick S. Parfrey,John D. Harnett,John D. Harnett,Gloria M. Kent,Gloria M. Kent,Christopher J. Martin,Christopher J. Martin,David C. Murray,David C. Murray,Paul E. Barre,Paul E. Barre +12 more
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Ron D. Hays,Leo S. Morales +1 more
TL;DR: This paper provides example applications of the RAND-36 cross-sectionally and longitudinally, provides information on what a clinically important difference is for the Rand-36 scales, and provides guidance for summarizing theRand-36 in a single number.
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