Journal ArticleDOI
Normalization of Hemoglobin Level in Patients with Chronic Kidney Disease and Anemia
Tilman B. Drüeke,Francesco Locatelli,Naomi Clyne,Kai-Uwe Eckardt,Iain C. Macdougall,Dimitrios Tsakiris,Hans-Ulrich Burger,Armin Scherhag +7 more
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TLDR
In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events and there was no significant difference in the combined incidence of adverse events between the two groups.Abstract:
BACKGROUND Whether correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes is not established. METHODS We randomly assigned 603 patients with an estimated glomerular filtration rate (GFR) of 15.0 to 35.0 ml per minute per 1.73 m 2 of body-surface area and mild-to-moderate anemia (hemoglobin level, 11.0 to 12.5 g per deciliter) to a target hemoglobin value in the normal range (13.0 to 15.0 g per deciliter, group 1) or the subnormal range (10.5 to 11.5 g per deciliter, group 2). Subcutaneous erythropoietin (epoetin beta) was initiated at randomization (group 1) or only after the hemoglobin level fell below 10.5 g per deciliter (group 2). The primary end point was a composite of eight cardiovascular events; secondary end points included left ventricular mass index, quality-of-life scores, and the progression of chronic kidney disease. RESULTS During the 3-year study, complete correction of anemia did not affect the likelihood of a first cardiovascular event (58 events in group 1 vs. 47 events in group 2; hazard ratio, 0.78; 95% confidence interval, 0.53 to 1.14; P = 0.20). Left ventricular mass index remained stable in both groups. The mean estimated GFR was 24.9 ml per minute in group 1 and 24.2 ml per minute in group 2 at baseline and decreased by 3.6 and 3.1 ml per minute per year, respectively (P = 0.40). Dialysis was required in more patients in group 1 than in group 2 (127 vs. 111, P = 0.03). General health and physical function improved significantly (P = 0.003 and P<0.001, respectively, in group 1, as compared with group 2). There was no significant difference in the combined incidence of adverse events between the two groups, but hypertensive episodes and headaches were more prevalent in group 1. CONCLUSIONS In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events. (ClinicalTrials.gov number, NCT00321919.)read more
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Journal ArticleDOI
Management of the Diabetic Patient with Advanced Chronic Kidney Disease
TL;DR: With heightened awareness of risks and a multifactorial management approach, the impact of DKD on micro‐ and macrovascular complications and death can be reduced.
Journal ArticleDOI
A central role for hypoxia-inducible factor (HIF)-2α in hepatic glucose homeostasis
TL;DR: This review focuses on the role of the oxygen sensing signaling in the regulation of hepatic glucose output with an emphasis on hypoxia inducible factor (HIF)-2α.
Journal ArticleDOI
Anaemia management in patients with chronic kidney disease: Taiwan practice guidelines.
Szu Chun Hung,Ko Lin Kuo,Der Cherng Tarng,Der Cherng Tarng,Chih Cheng Hsu,Mai Szu Wu,Tung Po Huang +6 more
TL;DR: The experience of CKD anaemia management in Taiwan demonstrated that a reasonable haemoglobin target can be achieved by using the lowest possible ESA dose and intravenous iron supplementation.
Journal ArticleDOI
Cardiorenal syndrome type 4: From chronic kidney disease to cardiovascular impairment.
Antonio Granata,Anna Clementi,Grazia Maria Virzì,Alessandra Brocca,Massimo de Cal,Scarfia Vr,Luca Zanoli,Claudio Ronco,Salvatore Corrao,Lorenzo Malatino +9 more
TL;DR: Patients with CKD should be thoroughly evaluated for cardiovascular risk factors that require careful management, given the significant burden of CRS type 4 on the healthcare system.
Journal ArticleDOI
Erythropoietin in cardiac disease: new features of an old drug.
Willem-Peter T. Ruifrok,Rudolf A. de Boer,B. Daan Westenbrink,Dirk J. van Veldhuisen,Wiek H. van Gilst +4 more
TL;DR: It is postulate that intermittent administration or a lower than conventional dose of erythropoietin will provide powerful cellular protection and will improve cardiac outcome, without the side effects of ERYthropoietsin associated with increased haematocrit.
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Journal ArticleDOI
Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease
Ajay K. Singh,Lynda A. Szczech,Kezhen L. Tang,Huiman X. Barnhart,Shelly Sapp,Marsha Wolfson,Donal N. Reddan,Abstr Act +7 more
TL;DR: The use of a target hemoglobin level of 13.5 g per deciliter (as compared with 11.3 g perDeciliter) was associated with increased risk and no incremental improvement in the quality of life and the use of epoetin alfa targeted to achieve a level of 11.4 g perdeciliter was not associated with an increased risk.
Journal ArticleDOI
The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.
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
TL;DR: In patients with clinically evident congestive heart failure or ischemic heart disease who are receiving hemodialysis, administration of epoetin to raise their hematocrit to 42 percent is not recommended.
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