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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KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD
Alan S. Kliger,Robert N. Foley,David S. Goldfarb,Stuart L. Goldstein,Kirsten L. Johansen,Ajay K. Singh,Lynda A. Szczech +6 more
TL;DR: While the KDIGO guideline stresses the potential risks of intravenous iron therapy, withholding iron might have its own risks and the recommendation to avoid hemoglobin levels falling below 9 g/dL sets a lower bound of "acceptability" that may increase blood transfusion.
Journal ArticleDOI
Hemoglobin Variability and Mortality in ESRD
Wei Yang,Rubeen K. Israni,Steven M. Brunelli,Marshall M. Joffe,Steven Fishbane,Harold I. Feldman +5 more
TL;DR: It is concluded that greater hemoglobin variability is independently associated with higher mortality.
Journal ArticleDOI
Arterial Hypertension Induced by Erythropoietin and Erythropoiesis-Stimulating Agents (ESA)
Reto Krapf,Henry N. Hulter +1 more
TL;DR: The evidence for a hypertensinogenic effect of erythropoiesis-stimulating agents (ESAs) in normal subjects, predialysis CKD, hemodialysis, and CAPD patients is compelling, and the potential for the development of future agents that might act as specific stimulators of eriesis, devoid of direct hemodynamic side effects is underscored.
Journal ArticleDOI
Mechanisms of Disease: erythropoietin resistance in patients with both heart and kidney failure
TL;DR: It is important to understand how cardiorenal failure affects EPO production and function as resistance to exogenous EPO is associated with an increased risk of death.
Journal ArticleDOI
Dose of erythropoiesis-stimulating agents and adverse outcomes in CKD: a metaregression analysis.
Ioannis Koulouridis,Mansour Alfayez,Thomas A Trikalinos,Thomas A Trikalinos,Ethan M Balk,Bertrand L. Jaber +5 more
TL;DR: In patients with CKD, higher ESA dose might be associated with all-cause mortality and cardiovascular complications independent of hemoglobin level, and use of epoetin alfa-equivalent doses is recommended.
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